Provider Demographics
NPI:1164618963
Name:DAVID B. SUTTER, M.D., P.A.
Entity Type:Organization
Organization Name:DAVID B. SUTTER, M.D., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:BRAND
Authorized Official - Last Name:SUTTER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:201-848-1731
Mailing Address - Street 1:638 SUMMIT AVE
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN LAKES
Mailing Address - State:NJ
Mailing Address - Zip Code:07417-1734
Mailing Address - Country:US
Mailing Address - Phone:201-848-1731
Mailing Address - Fax:
Practice Address - Street 1:638 SUMMIT AVE
Practice Address - Street 2:
Practice Address - City:FRANKLIN LAKES
Practice Address - State:NJ
Practice Address - Zip Code:07417-1734
Practice Address - Country:US
Practice Address - Phone:201-848-1731
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-14
Last Update Date:2013-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA03126800207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ25MA03126800OtherNJ LICENSE
NJ7271107Medicaid
31D0110140OtherCLIA NUMBER
NJ7271107Medicaid
NJ25MA03126800OtherNJ LICENSE
SU459680Medicare PIN
31D0110140OtherCLIA NUMBER