Individual
SUSANNAH S WISE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
125 PATERSON ST, SUITE 4100, NEW BRUNSWICK, NJ 08901-1962
(732) 235-7920
(732) 235-7079
Mailing address
66 W GILBERT ST, 2ND FLOOR, TINTON FALLS, NJ 07701-4947
(732) 212-0051
(732) 212-0713
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
MA074927
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
9031901
—
NJ
Enumeration date
08/30/2006
Last updated
08/07/2012
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