Provider Demographics
NPI:1013944917
Name:SUSSMAN, ROBERT E (DPM)
Entity type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:E
Last Name:SUSSMAN
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2100 STATE ROUTE 33 STE 3
Mailing Address - Street 2:
Mailing Address - City:NEPTUNE
Mailing Address - State:NJ
Mailing Address - Zip Code:07753-6116
Mailing Address - Country:US
Mailing Address - Phone:732-776-7260
Mailing Address - Fax:732-774-8370
Practice Address - Street 1:2100 STATE ROUTE 33 STE 3
Practice Address - Street 2:
Practice Address - City:NEPTUNE
Practice Address - State:NJ
Practice Address - Zip Code:07753-6116
Practice Address - Country:US
Practice Address - Phone:732-776-7260
Practice Address - Fax:732-774-8370
Is Sole Proprietor?:No
Enumeration Date:2006-06-27
Last Update Date:2022-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MD01549000213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ3382401Medicaid
NJ199742Medicare ID - Type Unspecified
E53407Medicare UPIN