Provider Demographics
NPI:1740714328
Name:SU, JANINE
Entity type:Individual
Prefix:MRS
First Name:JANINE
Middle Name:
Last Name:SU
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 1:8 HENDERSON CT
Mailing Address - Street 2:
Mailing Address - City:POMPTON LAKES
Mailing Address - State:NJ
Mailing Address - Zip Code:07442-2122
Mailing Address - Country:US
Mailing Address - Phone:973-288-3307
Mailing Address - Fax:
Practice Address - Street 1:8 HENDERSON CT
Practice Address - Street 2:
Practice Address - City:POMPTON LAKES
Practice Address - State:NJ
Practice Address - Zip Code:07442-2122
Practice Address - Country:US
Practice Address - Phone:973-288-3307
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-04-20
Last Update Date:2017-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY325635164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse