Individual
MS. SUSANNE R WALTHER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
APN
Contact information
Practice address
150 BERGEN ST, G244, NEWARK, NJ 07103-2496
(973) 972-0147
Mailing address
522 PARK ST, MONTCLAIR, NJ 07043-1952
(973) 972-0147
Taxonomy
Speciality
Code
Description
License number
State
282N00000X
General Acute Care Hospital
Primary
26NJ06108300
NJ
Other
Enumeration date
02/28/2007
Last updated
07/08/2007
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