Provider Demographics
NPI:1821108937
Name:ZEVELOFF, SUSAN (MD)
Entity Type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:
Last Name:ZEVELOFF
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 1:136 NORTH WASHINGTON AVE.
Mailing Address - Street 2:SUITE 102
Mailing Address - City:BERGENFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07621-1738
Mailing Address - Country:US
Mailing Address - Phone:201-387-2040
Mailing Address - Fax:201-385-9308
Practice Address - Street 1:136 NORTH WASHINGTON AVE.
Practice Address - Street 2:SUITE 102
Practice Address - City:BERGENFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07621-1738
Practice Address - Country:US
Practice Address - Phone:201-387-2040
Practice Address - Fax:201-385-9308
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ48181207R00000X, 207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0730700Medicaid
NJ48181OtherNJ STATE ID #
NJ48181OtherNJ STATE ID #
C63018Medicare UPIN
NJZE656309Medicare ID - Type Unspecified