Provider Demographics
NPI:1730547480
Name:EZZI, SUSAN (ANP)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:
Last Name:EZZI
Suffix:
Gender:F
Credentials:ANP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:131 MORRISTOWN RD
Mailing Address - Street 2:
Mailing Address - City:BASKING RIDGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07920-1654
Mailing Address - Country:US
Mailing Address - Phone:908-630-9305
Mailing Address - Fax:
Practice Address - Street 1:1086 DUMONT CIR
Practice Address - Street 2:
Practice Address - City:VOORHEES
Practice Address - State:NJ
Practice Address - Zip Code:08043-3500
Practice Address - Country:US
Practice Address - Phone:856-454-9100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-02-09
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ00617200363LG0600X, 363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ26NO12373900OtherNJ BOARD OF NURSING
NJP00686400OtherNJ OFFICE OF THE ATTORNEY GENERAL DIVISION OF CONSUMER AFFAIRS CDS
NJ26NJ00617200OtherNJ BOARD OF NURSING
NJ26NJ00617200OtherNJ BOARD OF NURSING
MR3862629OtherUS DEPT. OF JUSTICE DEA