Provider Demographics
NPI:1265605919
Name:SKALSKY BALES, SUSAN ELEANOR (MD)
Entity type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:ELEANOR
Last Name:SKALSKY BALES
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:SUSAN
Other - Middle Name:ELEANOR
Other - Last Name:SKALSKY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:31 GLADDING ROAD
Mailing Address - Street 2:
Mailing Address - City:CALDWELL
Mailing Address - State:NJ
Mailing Address - Zip Code:07006-5804
Mailing Address - Country:US
Mailing Address - Phone:973-226-5311
Mailing Address - Fax:973-226-5311
Practice Address - Street 1:31 GLADDING ROAD
Practice Address - Street 2:
Practice Address - City:CALDWELL
Practice Address - State:NJ
Practice Address - Zip Code:07006-5804
Practice Address - Country:US
Practice Address - Phone:973-226-5311
Practice Address - Fax:973-226-5311
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-02
Last Update Date:2016-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA038387002080A0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJF19215Medicare UPIN