Provider Demographics
NPI:1881641900
Name:MOORE, SUSAN SALZBERG (MD)
Entity Type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:SALZBERG
Last Name:MOORE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:521 NEWMAN SPRINGS RD
Mailing Address - Street 2:SUITE 12
Mailing Address - City:LINCROFT
Mailing Address - State:NJ
Mailing Address - Zip Code:07738-1463
Mailing Address - Country:US
Mailing Address - Phone:732-747-0022
Mailing Address - Fax:732-747-8600
Practice Address - Street 1:521 NEWMAN SPRINGS RD
Practice Address - Street 2:SUITE 12
Practice Address - City:LINCROFT
Practice Address - State:NJ
Practice Address - Zip Code:07738-1463
Practice Address - Country:US
Practice Address - Phone:732-747-0022
Practice Address - Fax:732-747-8600
Is Sole Proprietor?:No
Enumeration Date:2006-05-27
Last Update Date:2021-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA06256200207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJF79567Medicare UPIN
NJ800464C65Medicare ID - Type Unspecified