Provider Demographics
NPI:1174501886
Name:MORRISON, SUSAN HAGEN (MD)
Entity Type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:HAGEN
Last Name:MORRISON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MISS
Other - First Name:SUSAN
Other - Middle Name:MARIE
Other - Last Name:HAGEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:77 NEWARK AVE STE 4
Mailing Address - Street 2:
Mailing Address - City:BELLEVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:07109-4154
Mailing Address - Country:US
Mailing Address - Phone:973-450-0100
Mailing Address - Fax:973-450-8088
Practice Address - Street 1:77 NEWARK AVE STE 4
Practice Address - Street 2:
Practice Address - City:BELLEVILLE
Practice Address - State:NJ
Practice Address - Zip Code:07109-4154
Practice Address - Country:US
Practice Address - Phone:973-450-0100
Practice Address - Fax:973-450-8088
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-03
Last Update Date:2021-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA04095002080P0208X
NJ25MA04095600207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
No2080P0208XAllopathic & Osteopathic PhysiciansPediatricsPediatric Infectious Diseases
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ2091607Medicaid
NJ563230Medicare PIN
NJE23756Medicare UPIN