Provider Demographics
NPI:1922060334
Name:EGAN, SUSAN MARY (APN)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:MARY
Last Name:EGAN
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:94 PLEASANT HILL RD
Mailing Address - Street 2:
Mailing Address - City:RANDOLPH
Mailing Address - State:NJ
Mailing Address - Zip Code:07869-3466
Mailing Address - Country:US
Mailing Address - Phone:973-927-3597
Mailing Address - Fax:973-401-2140
Practice Address - Street 1:100 E HANOVER AVE
Practice Address - Street 2:
Practice Address - City:CEDAR KNOLLS
Practice Address - State:NJ
Practice Address - Zip Code:07927-2020
Practice Address - Country:US
Practice Address - Phone:973-401-2121
Practice Address - Fax:973-625-7116
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-03
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ00080900163WP0809X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0809XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, Adult
Provider Identifiers
StateIdentifier IDID TypeIssuer
NHP00195000OtherCDS#
NHP00195000OtherCDS#