Individual
MARYANN SOUS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
350 ENGLE ST, ENGLEWOOD, NJ 07631-1808
(201) 894-3636
Mailing address
100 E LANCASTER AVE, WYNNEWOOD, PA 19096-3450
(484) 476-1000
(484) 476-9000
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
25MP00391600
NJ
363AM0700X
Medical Physician Assistant
MA060141
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0867586
—
NJ
Enumeration date
08/21/2015
Last updated
03/25/2025
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