Basic Information
| Provider Information | |||||||||
| NPI: | 1871742080 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BLUMENFELD | ||||||||
| FirstName: | SUSAN | ||||||||
| MiddleName: | J | ||||||||
| NamePrefix: | MS. | ||||||||
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| Credential: | RNCPNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 250 HADDONFIELD BERLIN RD | ||||||||
| Address2: | SUITE 105 | ||||||||
| City: | GIBBSBORO | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 080261228 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8563460005 | ||||||||
| FaxNumber: | 8567841799 | ||||||||
| Practice Location | |||||||||
| Address1: | 250 HADDONFIELD BERLIN RD | ||||||||
| Address2: | SUITE 105 | ||||||||
| City: | GIBBSBORO | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 080261228 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8563460005 | ||||||||
| FaxNumber: | 8567841799 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/11/2008 | ||||||||
| LastUpdateDate: | 03/21/2013 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LP0200X | 26NN08688200 | NJ | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Pediatrics |
No ID Information.