Provider Demographics
NPI:1851368062
Name:SUSSMAN, JAY (MD)
Entity Type:Individual
Prefix:DR
First Name:JAY
Middle Name:
Last Name:SUSSMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 IRONGATE LN
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:NJ
Mailing Address - Zip Code:08055-3511
Mailing Address - Country:US
Mailing Address - Phone:609-953-0108
Mailing Address - Fax:
Practice Address - Street 1:401 YOUNG AVE
Practice Address - Street 2:SUITE 275
Practice Address - City:MOORESTOWN
Practice Address - State:NJ
Practice Address - Zip Code:08057-3130
Practice Address - Country:US
Practice Address - Phone:856-291-8855
Practice Address - Fax:856-291-8844
Is Sole Proprietor?:No
Enumeration Date:2006-03-07
Last Update Date:2023-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA05311000207RC0000X, 207UN0901X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207UN0901XAllopathic & Osteopathic PhysiciansNuclear MedicineNuclear Cardiology
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
2K5353OtherHEALTHNET
BNS047OtherOXFORD
0004100785OtherAETNA
NJ0602701Medicaid
0004100785OtherAETNA
BNS047OtherOXFORD
NJC11807Medicare UPIN