Provider Demographics
NPI:1750135570
Name:SOUZA OLINGER, JUSSARA
Entity type:Individual
Prefix:MRS
First Name:JUSSARA
Middle Name:
Last Name:SOUZA OLINGER
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 1:18 DEVON CT
Mailing Address - Street 2:
Mailing Address - City:HAMBURG
Mailing Address - State:NJ
Mailing Address - Zip Code:07419-1537
Mailing Address - Country:US
Mailing Address - Phone:646-617-9364
Mailing Address - Fax:
Practice Address - Street 1:535 BERGEN BLVD STE 4
Practice Address - Street 2:
Practice Address - City:RIDGEFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07657-2820
Practice Address - Country:US
Practice Address - Phone:551-228-3471
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-17
Last Update Date:2024-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes246Z00000XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherGroup - Single Specialty