Provider Demographics
NPI:1467608463
Name:CORSENTINO, SUE ANNE (APN, C)
Entity Type:Individual
Prefix:
First Name:SUE ANNE
Middle Name:
Last Name:CORSENTINO
Suffix:
Gender:F
Credentials:APN, C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2143 NEW VILLAGE RD
Mailing Address - Street 2:
Mailing Address - City:STEWARTSVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08886-2662
Mailing Address - Country:US
Mailing Address - Phone:908-447-1505
Mailing Address - Fax:
Practice Address - Street 1:1 ROBERT WOOD JOHNSON PL
Practice Address - Street 2:
Practice Address - City:NEW BRUNSWICK
Practice Address - State:NJ
Practice Address - Zip Code:08901-1928
Practice Address - Country:US
Practice Address - Phone:732-828-3000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-11
Last Update Date:2011-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ00163000363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ802453C50Medicare PIN