Provider Demographics
NPI:1346935822
Name:SUSS, ERIC
Entity Type:Individual
Prefix:
First Name:ERIC
Middle Name:
Last Name:SUSS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3777 INDEPENDENCE AVE APT 3L
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10463-1412
Mailing Address - Country:US
Mailing Address - Phone:917-848-9142
Mailing Address - Fax:
Practice Address - Street 1:110 WILLIAM ST
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:NJ
Practice Address - Zip Code:07102-1304
Practice Address - Country:US
Practice Address - Phone:973-733-7600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-10
Last Update Date:2023-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program