Provider Demographics
NPI:1194724575
Name:OBERLENDER, SUSAN B (MD)
Entity type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:B
Last Name:OBERLENDER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 1710
Mailing Address - Street 2:SOUTH JERSEY RADIOLOGY ASSOCIATES, PA
Mailing Address - City:VOORHEES
Mailing Address - State:NJ
Mailing Address - Zip Code:08043-7710
Mailing Address - Country:US
Mailing Address - Phone:856-770-0504
Mailing Address - Fax:856-770-0395
Practice Address - Street 1:100 CARNIE BLVD
Practice Address - Street 2:SUITE B-5
Practice Address - City:VOORHEES
Practice Address - State:NJ
Practice Address - Zip Code:08043-4512
Practice Address - Country:US
Practice Address - Phone:856-751-0123
Practice Address - Fax:856-751-0535
Is Sole Proprietor?:No
Enumeration Date:2005-07-19
Last Update Date:2012-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA063942002085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OB880262OtherPREMIER BLUE
1088247OtherHORIZON NJ HEALTH
A3738029OtherOXFORD HEALTH
1542532OtherUNITED HEALTHCARE
0036765000OtherAMERIHEALTH
0732404OtherAETNA
300067174OtherRAILROAD MEDICARE
NJ6940307Medicaid
OB880262OtherHIGHMARK PA BLUE SHIELD
NJE93615Medicare UPIN
NJ6940307Medicaid