Provider Demographics
NPI:1851414072
Name:ROBERT E. SUSSMAN, D.P.M.,P.C.
Entity Type:Organization
Organization Name:ROBERT E. SUSSMAN, D.P.M.,P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROPRIETOR
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:E
Authorized Official - Last Name:SUSSMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:732-776-7260
Mailing Address - Street 1:2100 STATE ROUTE 33 STE 3
Mailing Address - Street 2:
Mailing Address - City:NEPTUNE
Mailing Address - State:NJ
Mailing Address - Zip Code:07753-6116
Mailing Address - Country:US
Mailing Address - Phone:732-776-7260
Mailing Address - Fax:732-774-8370
Practice Address - Street 1:2100 STATE ROUTE 33 STE 3
Practice Address - Street 2:
Practice Address - City:NEPTUNE
Practice Address - State:NJ
Practice Address - Zip Code:07753-6116
Practice Address - Country:US
Practice Address - Phone:732-776-7260
Practice Address - Fax:732-774-8370
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-10
Last Update Date:2022-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MD01549000213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ3382401Medicaid
NJE53407Medicare UPIN
NJ0772850001Medicare NSC
NJ3382401Medicaid