Provider Demographics
NPI:1518281245
Name:SUSAN HAGEN MORRISON, M.D., PA
Entity Type:Organization
Organization Name:SUSAN HAGEN MORRISON, M.D., PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:HAGEN
Authorized Official - Last Name:MORRISON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:973-450-0100
Mailing Address - Street 1:77 NEWARK AVE STE 4
Mailing Address - Street 2:
Mailing Address - City:BELLEVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:07109-4154
Mailing Address - Country:US
Mailing Address - Phone:973-450-0100
Mailing Address - Fax:973-450-8088
Practice Address - Street 1:77 NEWARK AVE STE 4
Practice Address - Street 2:
Practice Address - City:BELLEVILLE
Practice Address - State:NJ
Practice Address - Zip Code:07109-4154
Practice Address - Country:US
Practice Address - Phone:973-450-0100
Practice Address - Fax:973-450-8088
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-24
Last Update Date:2021-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA04095600207K00000X, 2080P0208X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyGroup - Single Specialty
No2080P0208XAllopathic & Osteopathic PhysiciansPediatricsPediatric Infectious DiseasesGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ2091607Medicaid
NJE23756Medicare UPIN
NJ2091607Medicaid