Provider Demographics
NPI:1639314925
Name:NYQUIST, SUSAN SHOSHANA (MD)
Entity Type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:SHOSHANA
Last Name:NYQUIST
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:123 EGG HARBOR RD
Mailing Address - Street 2:SUITE 300
Mailing Address - City:SEWELL
Mailing Address - State:NJ
Mailing Address - Zip Code:08080-9406
Mailing Address - Country:US
Mailing Address - Phone:856-290-4548
Mailing Address - Fax:856-290-4552
Practice Address - Street 1:123 EGG HARBOR RD
Practice Address - Street 2:SUITE 300
Practice Address - City:SEWELL
Practice Address - State:NJ
Practice Address - Zip Code:08080-9406
Practice Address - Country:US
Practice Address - Phone:856-290-4548
Practice Address - Fax:856-290-4552
Is Sole Proprietor?:No
Enumeration Date:2008-12-16
Last Update Date:2013-04-25
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NJ25MA09223200207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0327409Medicaid
NJ3893303000OtherAMERIHEALTH
NJ3893303000OtherAMERIHEALTH