Provider Demographics
NPI:1851834188
Name:ENGEL, SUSAN (LAC)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:
Last Name:ENGEL
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:275 SUSSEX AVE
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07107-3120
Mailing Address - Country:US
Mailing Address - Phone:973-454-8594
Mailing Address - Fax:
Practice Address - Street 1:41 ELM ST
Practice Address - Street 2:SUITE 1U
Practice Address - City:MORRISTOWN
Practice Address - State:NJ
Practice Address - Zip Code:07960-7201
Practice Address - Country:US
Practice Address - Phone:973-454-8594
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-18
Last Update Date:2016-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MZ00120500171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist