Provider Demographics
NPI:1457590325
Name:JAMES J SUSACK DMD PC
Entity Type:Organization
Organization Name:JAMES J SUSACK DMD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:J
Authorized Official - Last Name:SUSACK
Authorized Official - Suffix:JR
Authorized Official - Credentials:DMD
Authorized Official - Phone:856-678-2033
Mailing Address - Street 1:151 N BROADWAY
Mailing Address - Street 2:
Mailing Address - City:PENNSVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08070-1648
Mailing Address - Country:US
Mailing Address - Phone:856-678-2033
Mailing Address - Fax:856-678-2845
Practice Address - Street 1:151 N BROADWAY
Practice Address - Street 2:
Practice Address - City:PENNSVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08070-1648
Practice Address - Country:US
Practice Address - Phone:856-678-2033
Practice Address - Fax:856-678-2845
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-16
Last Update Date:2009-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJDI018099261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental