Provider Demographics
NPI:1497971154
Name:WARD, SUSAN PAGACH (OTR)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:PAGACH
Last Name:WARD
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:618 RIVERWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:POINT PLEASANT BORO
Mailing Address - State:NJ
Mailing Address - Zip Code:08742-2719
Mailing Address - Country:US
Mailing Address - Phone:732-899-0051
Mailing Address - Fax:
Practice Address - Street 1:618 RIVERWOOD AVE
Practice Address - Street 2:
Practice Address - City:POINT PLEASANT BORO
Practice Address - State:NJ
Practice Address - Zip Code:08742-2719
Practice Address - Country:US
Practice Address - Phone:732-899-0051
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ46TR00070200171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor