Provider Demographics
NPI:1386233062
Name:INCI, SUZAN B (APN, RN)
Entity Type:Individual
Prefix:MRS
First Name:SUZAN
Middle Name:B
Last Name:INCI
Suffix:
Gender:F
Credentials:APN, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:748 NEW YORK AVE
Mailing Address - Street 2:
Mailing Address - City:LYNDHURST
Mailing Address - State:NJ
Mailing Address - Zip Code:07071-1623
Mailing Address - Country:US
Mailing Address - Phone:973-557-0030
Mailing Address - Fax:
Practice Address - Street 1:95 MAIN AVE STE 274
Practice Address - Street 2:
Practice Address - City:CLIFTON
Practice Address - State:NJ
Practice Address - Zip Code:07014-1748
Practice Address - Country:US
Practice Address - Phone:973-557-0030
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-15
Last Update Date:2021-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ01087600363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care