Provider Demographics
NPI:1558369629
Name:ENTMACHER, SUSAN D (MD)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:D
Last Name:ENTMACHER
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 1:703 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MOORESTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:08057-3082
Mailing Address - Country:US
Mailing Address - Phone:856-727-0900
Mailing Address - Fax:856-231-8428
Practice Address - Street 1:703 E MAIN ST
Practice Address - Street 2:
Practice Address - City:MOORESTOWN
Practice Address - State:NJ
Practice Address - Zip Code:08057-3082
Practice Address - Country:US
Practice Address - Phone:856-727-0900
Practice Address - Fax:856-231-8428
Is Sole Proprietor?:No
Enumeration Date:2005-07-12
Last Update Date:2007-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA04847800207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0967602Medicaid
NJ452627CSFMedicare PIN
NJ0967602Medicaid