Provider Demographics
NPI:1326279795
Name:JOHN IVAN SUTTER, MD, PA
Entity Type:Organization
Organization Name:JOHN IVAN SUTTER, MD, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:IVAN
Authorized Official - Last Name:SUTTER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:973-778-2083
Mailing Address - Street 1:925 CLIFTON AVE
Mailing Address - Street 2:SUITE 102
Mailing Address - City:CLIFTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07013-2724
Mailing Address - Country:US
Mailing Address - Phone:973-778-2083
Mailing Address - Fax:973-778-1584
Practice Address - Street 1:925 CLIFTON AVE
Practice Address - Street 2:SUITE 102
Practice Address - City:CLIFTON
Practice Address - State:NJ
Practice Address - Zip Code:07013-2724
Practice Address - Country:US
Practice Address - Phone:973-778-2083
Practice Address - Fax:973-778-1584
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-04
Last Update Date:2009-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA03777100208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty