Provider Demographics
NPI:1427098193
Name:SLATER, SUSAN M (MPT,OCS)
Entity type:Individual
Prefix:MISS
First Name:SUSAN
Middle Name:M
Last Name:SLATER
Suffix:
Gender:F
Credentials:MPT,OCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 E UNION AVE
Mailing Address - Street 2:
Mailing Address - City:BOUND BROOK
Mailing Address - State:NJ
Mailing Address - Zip Code:08805-1762
Mailing Address - Country:US
Mailing Address - Phone:732-868-9018
Mailing Address - Fax:732-868-5112
Practice Address - Street 1:200 E UNION AVE
Practice Address - Street 2:
Practice Address - City:BOUND BROOK
Practice Address - State:NJ
Practice Address - Zip Code:08805-1762
Practice Address - Country:US
Practice Address - Phone:732-868-9018
Practice Address - Fax:732-868-5112
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-08
Last Update Date:2015-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA00456200225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ650022084OtherPALMETTO GBA
NJ0004562NJ01OtherANTHEM HEALTH
NJ000815669OtherAMERIHEALTH CASUALTY
NJ129266178OtherTRICARE
NJ223631294OtherHORIZON BCBS
NJTS151OtherOXFORD
NJ115946000OtherUS DEPT OF LABOR
NJ223631294OtherMAGNACARE
NJ5183705OtherNORTH AMERICAN ADMIN
NJ5183705OtherCCN
NJ0552319OtherAETNA
NJ369972OtherONE HEALTH
NJ1043757OtherFIRST HEALTH
NJ1K2449OtherHEALTH NET
NJ2938OtherMASTERCARE
NJ223631294OtherHORIZON BCBS