Provider Demographics
NPI:1851691687
Name:WISSEN, SUSANN (PT)
Entity Type:Individual
Prefix:
First Name:SUSANN
Middle Name:
Last Name:WISSEN
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:51 WASHINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:WEST CALDWELL
Mailing Address - State:NJ
Mailing Address - Zip Code:07006-7703
Mailing Address - Country:US
Mailing Address - Phone:973-229-6627
Mailing Address - Fax:
Practice Address - Street 1:154 S LIVINGSTON AVE
Practice Address - Street 2:SUITE 204
Practice Address - City:LIVINGSTON
Practice Address - State:NJ
Practice Address - Zip Code:07039-3017
Practice Address - Country:US
Practice Address - Phone:973-229-6627
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-10-27
Last Update Date:2012-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA006572002251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics