Provider Demographics
NPI:1881637668
Name:RELE, SUSAN (PT, DPT, CERT MDT)
Entity Type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:
Last Name:RELE
Suffix:
Gender:F
Credentials:PT, DPT, CERT MDT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1631 LARKSPUR DR
Mailing Address - Street 2:
Mailing Address - City:MOUNTAINSIDE
Mailing Address - State:NJ
Mailing Address - Zip Code:07092-1346
Mailing Address - Country:US
Mailing Address - Phone:908-317-9742
Mailing Address - Fax:
Practice Address - Street 1:1111 US HIGHWAY 22
Practice Address - Street 2:
Practice Address - City:MOUNTAINSIDE
Practice Address - State:NJ
Practice Address - Zip Code:07092-2808
Practice Address - Country:US
Practice Address - Phone:908-389-9100
Practice Address - Fax:908-389-9101
Is Sole Proprietor?:No
Enumeration Date:2006-06-13
Last Update Date:2014-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA006476002251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ097760Medicare ID - Type Unspecified