Provider Demographics
NPI:1790726784
Name:GIMBAR, SUSAN - (RN, APN,C)
Entity Type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:-
Last Name:GIMBAR
Suffix:
Gender:F
Credentials:RN, APN,C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:36 GROVER LN
Mailing Address - Street 2:
Mailing Address - City:WEST CALDWELL
Mailing Address - State:NJ
Mailing Address - Zip Code:07006-7948
Mailing Address - Country:US
Mailing Address - Phone:973-364-0129
Mailing Address - Fax:973-364-0129
Practice Address - Street 1:36 GROVER LN
Practice Address - Street 2:
Practice Address - City:WEST CALDWELL
Practice Address - State:NJ
Practice Address - Zip Code:07006-7948
Practice Address - Country:US
Practice Address - Phone:973-364-0129
Practice Address - Fax:973-364-0129
Is Sole Proprietor?:No
Enumeration Date:2006-06-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ00041600363LP0808X
NYF400717363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health