Provider Demographics
NPI:1831190990
Name:SUSSMAN, ROBERT (MD)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:
Last Name:SUSSMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 416457
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02241-6457
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1 SPRINGFIELD AVE
Practice Address - Street 2:FIRST FLOOR
Practice Address - City:SUMMIT
Practice Address - State:NJ
Practice Address - Zip Code:07901-4055
Practice Address - Country:US
Practice Address - Phone:908-934-0555
Practice Address - Fax:908-904-0556
Is Sole Proprietor?:No
Enumeration Date:2005-08-10
Last Update Date:2017-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA04968100174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ222233003OtherHORIZON BC
NJ25F581OtherEMPIRE HEALTH
NJ121410OtherCHN INS.
NJES259OtherOXFORD INS.
NJ222233003007OtherCIGNA INS.
NJ4116257OtherAETNA INS
NJES259OtherOXFORD INS.
NJ005151AP7Medicare ID - Type UnspecifiedMEDICARE