Provider Demographics
NPI:1952458903
Name:SUCZEWSKI, EDWARD J (MD)
Entity Type:Individual
Prefix:
First Name:EDWARD
Middle Name:J
Last Name:SUCZEWSKI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:323 AVENUE E
Mailing Address - Street 2:CORNER OF 25TH ST
Mailing Address - City:BAYONNE
Mailing Address - State:NJ
Mailing Address - Zip Code:07002-4612
Mailing Address - Country:US
Mailing Address - Phone:201-339-8600
Mailing Address - Fax:201-339-2894
Practice Address - Street 1:323 AVENUE E
Practice Address - Street 2:CORNER OF 25TH ST
Practice Address - City:BAYONNE
Practice Address - State:NJ
Practice Address - Zip Code:07002-4612
Practice Address - Country:US
Practice Address - Phone:201-339-8600
Practice Address - Fax:201-339-2894
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-04
Last Update Date:2014-09-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NJ25MA04388300207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ488549Medicare PIN