| Susan G Blank, Md, Llc | |
|
45 Brant Ave Suite 2 Clark NJ 07066-1562 | |
| (732) 340-0300 | |
| (732) 340-9300 |
| Full Name | Susan G Blank, Md, Llc |
|---|---|
| Speciality | Psychiatry & Neurology |
| Location | 45 Brant Ave, Clark, New Jersey |
| Authorized Official Name and Position | Susan G Blank (OWNER) |
| Authorized Official Contact | 7323400300 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Susan G Blank, Md, Llc 45 Brant Ave Suite 2 Clark NJ 07066-1562 Ph: (732) 340-0300 | Susan G Blank, Md, Llc 45 Brant Ave Suite 2 Clark NJ 07066-1562 Ph: (732) 340-0300 |
| NPI Number | 1164617668 |
|---|---|
| Provider Enumeration Date | 09/08/2007 |
| Last Update Date | 09/08/2007 |
| Medicare PECOS PAC ID | 2769498781 |
|---|---|
| Medicare Enrollment ID | O20060301000151 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1164617668 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084P0800X | Psychiatry & Neurology - Psychiatry | 25MA05151700 (New Jersey) | Primary |
| Provider Name | Susan G Blank |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1841319662 PECOS PAC ID: 9931115953 Enrollment ID: I20060301000172 |
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