Provider Demographics
NPI:1104894195
Name:BELANGER, SUSAN LYNN (DPM)
Entity type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:LYNN
Last Name:BELANGER
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1806 STATE ROUTE 35 STE 103
Mailing Address - Street 2:
Mailing Address - City:OAKHURST
Mailing Address - State:NJ
Mailing Address - Zip Code:07755-2766
Mailing Address - Country:US
Mailing Address - Phone:732-643-5500
Mailing Address - Fax:732-869-4522
Practice Address - Street 1:1806 STATE ROUTE 35 STE 103
Practice Address - Street 2:
Practice Address - City:OAKHURST
Practice Address - State:NJ
Practice Address - Zip Code:07755-2766
Practice Address - Country:US
Practice Address - Phone:732-643-5500
Practice Address - Fax:732-531-1035
Is Sole Proprietor?:No
Enumeration Date:2006-03-08
Last Update Date:2024-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MD00253200213ES0103X
NJNJ25MD00253200213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ9112707Medicaid
NJ043113Medicare PIN
NJU75778Medicare UPIN
NJ9112707Medicaid
NJ9112707Medicaid