Provider Demographics
NPI:1013190511
Name:OFFEN, SUZANNE R (O D)
Entity Type:Individual
Prefix:
First Name:SUZANNE
Middle Name:R
Last Name:OFFEN
Suffix:
Gender:F
Credentials:O D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:518 WESTFIELD AVENUE
Mailing Address - Street 2:
Mailing Address - City:WESTFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07090-3300
Mailing Address - Country:US
Mailing Address - Phone:908-789-1177
Mailing Address - Fax:908-789-7431
Practice Address - Street 1:518 WESTFIELD AVE
Practice Address - Street 2:
Practice Address - City:WESTFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07090-3312
Practice Address - Country:US
Practice Address - Phone:908-789-1177
Practice Address - Fax:908-789-7431
Is Sole Proprietor?:No
Enumeration Date:2007-12-07
Last Update Date:2007-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ27OA00437900152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ223335532OtherI.E. SHAFFER & CO.
NJ3319008Medicaid
NJ6638968OtherCIGNA HEALTHCARE
NJ41006253OtherRAILROAD MEDICARE
NJ223335532OtherUNITED HEALTHCARE
NJ223335532OtherBANKERS LIFE/CASUALTY
NJ000034945OtherHORIZON BC/BS OF NJ
NJ223335532OtherAETNA HEALTHCARE
NJ223335532OtherNGS
NJ223335532OtherMUTUAL OF OMAHA
NJ223335532OtherGREAT WEST
NJ223335532OtherHEALTHNET
NJ223335532OtherI.E. SHAFFER & CO.
NJ000034945OtherHORIZON BC/BS OF NJ
NJ223335532OtherBANKERS LIFE/CASUALTY