Provider Demographics
NPI:1346618840
Name:BERSIN, SUSAN (ANP)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:
Last Name:BERSIN
Suffix:
Gender:F
Credentials:ANP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1355 CAMPUS PKWY
Mailing Address - Street 2:SUITE 103
Mailing Address - City:WALL
Mailing Address - State:NJ
Mailing Address - Zip Code:07719-6840
Mailing Address - Country:US
Mailing Address - Phone:732-202-8071
Mailing Address - Fax:732-922-6026
Practice Address - Street 1:137 GROVE ST APT 2
Practice Address - Street 2:
Practice Address - City:BAY HEAD
Practice Address - State:NJ
Practice Address - Zip Code:08742-5027
Practice Address - Country:US
Practice Address - Phone:201-543-1515
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-14
Last Update Date:2015-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ00482600363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health