Individual
SUSANNA IM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
435 HURFFVILLE - CROSS KEYS RD, WASHINGTON TOWNSHIP, NJ 08080
(856) 582-2500
Mailing address
92 PEREGRINE DR, VOORHEES, NJ 08043-1661
(856) 246-2294
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
26NJ01244400
NJ
Other
Enumeration date
11/08/2021
Last updated
01/06/2022
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