Provider Demographics
NPI:1215013198
Name:GOMINGER, SUSAN G (RN,MS,APNC)
Entity Type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:G
Last Name:GOMINGER
Suffix:
Gender:F
Credentials:RN,MS,APNC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 JESSUP RD
Mailing Address - Street 2:
Mailing Address - City:PAULSBORO
Mailing Address - State:NJ
Mailing Address - Zip Code:08066-2413
Mailing Address - Country:US
Mailing Address - Phone:845-845-4061
Mailing Address - Fax:845-384-1770
Practice Address - Street 1:600 JESSUP RD
Practice Address - Street 2:
Practice Address - City:PAULSBORO
Practice Address - State:NJ
Practice Address - Zip Code:08066-2413
Practice Address - Country:US
Practice Address - Phone:845-845-4061
Practice Address - Fax:845-384-1770
Is Sole Proprietor?:No
Enumeration Date:2006-10-31
Last Update Date:2018-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NN05354100363LP1700X, 363LW0102X, 363LX0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology
No363LP1700XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPerinatal
No363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health