Basic Information
| Provider Information | |||||||||
| NPI: | 1023332715 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | O'BRIEN | ||||||||
| FirstName: | SUSAN | ||||||||
| MiddleName: | E. | ||||||||
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| Credential: | DO | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 859 | ||||||||
| Address2: | |||||||||
| City: | LIVINGSTON | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 070390859 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8003450064 | ||||||||
| FaxNumber: | 9732511109 | ||||||||
| Practice Location | |||||||||
| Address1: | 355 GRAND ST | ||||||||
| Address2: | JERSEY CITY MEDICAL CENTER | ||||||||
| City: | JERSEY CITY | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 073024321 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2019152000 | ||||||||
| FaxNumber: | 9732511109 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/24/2010 | ||||||||
| LastUpdateDate: | 03/24/2010 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | 25MB08684700 | NJ | Y | Allopathic & Osteopathic Physicians | Emergency Medicine |
No ID Information.