Provider Demographics
NPI:1063873222
Name:GRAY, SUSAN JO (APN)
Entity type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:JO
Last Name:GRAY
Suffix:
Gender:
Credentials:APN
Other - Prefix:MS
Other - First Name:SUSAN
Other - Middle Name:JO
Other - Last Name:WANDERMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:215 STATE ROUTE 31 RM 116
Mailing Address - Street 2:
Mailing Address - City:FLEMINGTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08822-5752
Mailing Address - Country:US
Mailing Address - Phone:908-284-1125
Mailing Address - Fax:908-284-2016
Practice Address - Street 1:190 HIGHWAY 31 STE 100
Practice Address - Street 2:
Practice Address - City:FLEMINGTON
Practice Address - State:NJ
Practice Address - Zip Code:08822-5773
Practice Address - Country:US
Practice Address - Phone:908-788-6654
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-16
Last Update Date:2025-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ006044002084P0800X, 283Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No283Q00000XHospitalsPsychiatric Hospital