Provider Demographics
NPI:1184948507
Name:CORFORTE, SUSAN
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:
Last Name:CORFORTE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:46 HAMPTON HOUSE RD
Mailing Address - Street 2:
Mailing Address - City:NEWTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07860-1409
Mailing Address - Country:US
Mailing Address - Phone:973-383-9735
Mailing Address - Fax:973-383-3601
Practice Address - Street 1:46 HAMPTON HOUSE RD
Practice Address - Street 2:
Practice Address - City:NEWTON
Practice Address - State:NJ
Practice Address - Zip Code:07860-1409
Practice Address - Country:US
Practice Address - Phone:973-383-9735
Practice Address - Fax:973-383-3601
Is Sole Proprietor?:No
Enumeration Date:2010-03-15
Last Update Date:2016-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MG00118100237700000X
PAFO3597237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist