Provider Demographics
NPI:1407848575
Name:SUTTER, JOHN IVAN (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:IVAN
Last Name:SUTTER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
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
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-16
Last Update Date:2010-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA0377712080A0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ223674880OtherHMO
NJ3078302Medicaid
NJ3078302Medicaid