Provider Demographics
NPI:1801881487
Name:SUSSMAN, BARRY
Entity type:Individual
Prefix:
First Name:BARRY
Middle Name:
Last Name:SUSSMAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:375 ENGLE ST
Mailing Address - Street 2:
Mailing Address - City:ENGLEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07631-1823
Mailing Address - Country:US
Mailing Address - Phone:201-894-0400
Mailing Address - Fax:201-894-1022
Practice Address - Street 1:375 ENGLE ST
Practice Address - Street 2:
Practice Address - City:ENGLEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07631-1823
Practice Address - Country:US
Practice Address - Phone:201-894-0400
Practice Address - Fax:201-894-1022
Is Sole Proprietor?:No
Enumeration Date:2005-09-20
Last Update Date:2009-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA03498600208600000X, 2086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ330001880OtherRAILROAD MEDICARE ID #
NJ0882801Medicaid
NJ330001880OtherRAILROAD MEDICARE ID #
NJ0882801Medicaid