Provider Demographics
NPI:1417988809
Name:KAISER, SUSAN (MD)
Entity Type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:
Last Name:KAISER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:JERSEY CITY MEDICAL CENTER 355 GRAND STREET
Mailing Address - Street 2:DEPARTMENT OF SURGERY 3 EAST
Mailing Address - City:JERSEY CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07302
Mailing Address - Country:US
Mailing Address - Phone:201-915-2451
Mailing Address - Fax:201-915-2192
Practice Address - Street 1:377 JERSEY AVE
Practice Address - Street 2:SUITE 220
Practice Address - City:JERSEY CITY
Practice Address - State:NJ
Practice Address - Zip Code:07302-4393
Practice Address - Country:US
Practice Address - Phone:201-309-2380
Practice Address - Fax:201-309-2381
Is Sole Proprietor?:No
Enumeration Date:2006-07-05
Last Update Date:2011-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA071936002086S0127X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0127XAllopathic & Osteopathic PhysiciansSurgeryTrauma Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ8474605Medicaid
NJ8474605Medicaid
E87309Medicare UPIN