Basic Information
| Provider Information | |||||||||
| NPI: | 1659460566 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SUTERA | ||||||||
| FirstName: | JACQUELINE | ||||||||
| MiddleName: | M | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | DPM | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 419430 | ||||||||
| Address2: | |||||||||
| City: | BOSTON | ||||||||
| State: | MA | ||||||||
| PostalCode: | 022419430 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2016663900 | ||||||||
| FaxNumber: | 2012610505 | ||||||||
| Practice Location | |||||||||
| Address1: | 452 OLD HOOK RD | ||||||||
| Address2: | 2ND FLOOR | ||||||||
| City: | EMERSON | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 076301381 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2016663900 | ||||||||
| FaxNumber: | 2012610505 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/11/2006 | ||||||||
| LastUpdateDate: | 04/28/2017 | ||||||||
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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 | 213ES0131X | N006030-2 | NY | N | Podiatric Medicine & Surgery Service Providers | Podiatrist | Foot Surgery | 213ES0131X | 25MD00279500 | NJ | Y | Podiatric Medicine & Surgery Service Providers | Podiatrist | Foot Surgery |
No ID Information.