Provider Demographics
NPI:1629028568
Name:MAIOCCO, SUSAN L (APN)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:L
Last Name:MAIOCCO
Suffix:
Gender:F
Credentials:APN
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Other - Credentials:
Mailing Address - Street 1:111 CENTRAL AVE
Mailing Address - Street 2:SAINT MICHAEL'S MEDICAL CENTER PRIMARYCARECLINIC1ST FL.
Mailing Address - City:NEWARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07102-1909
Mailing Address - Country:US
Mailing Address - Phone:973-877-5080
Mailing Address - Fax:973-877-2718
Practice Address - Street 1:111 CENTRAL AVE
Practice Address - Street 2:SAINT MICHAEL'S MEDICAL CENTER PRIMARYCARECLINIC1ST FL.
Practice Address - City:NEWARK
Practice Address - State:NJ
Practice Address - Zip Code:07102-1909
Practice Address - Country:US
Practice Address - Phone:973-877-5080
Practice Address - Fax:973-877-2718
Is Sole Proprietor?:No
Enumeration Date:2006-05-11
Last Update Date:2014-04-08
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Provider Licenses
StateLicense IDTaxonomies
NJ26NO05261700163W00000X
NJ26NJ00070900363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ096031Medicare PIN