Provider Demographics
NPI:1689784159
Name:LAGE, SUSAN M (DO)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:M
Last Name:LAGE
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:501 IRON BRIDGE RD STE 3
Mailing Address - Street 2:
Mailing Address - City:FREEHOLD
Mailing Address - State:NJ
Mailing Address - Zip Code:07728-5305
Mailing Address - Country:US
Mailing Address - Phone:732-462-7030
Mailing Address - Fax:732-308-3562
Practice Address - Street 1:501 IRON BRIDGE RD STE 3
Practice Address - Street 2:
Practice Address - City:FREEHOLD
Practice Address - State:NJ
Practice Address - Zip Code:07728-5305
Practice Address - Country:US
Practice Address - Phone:732-462-7030
Practice Address - Fax:732-308-3562
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2020-01-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NJ25MB056305002084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0558702Medicaid
H29161Medicare UPIN
NJ0558702Medicaid