Provider Demographics
NPI:1528096633
Name:SUSINNO, ROBERT A
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:A
Last Name:SUSINNO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 BROAD AVE
Mailing Address - Street 2:P.O. BOX 328
Mailing Address - City:PALISADES PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07650-1438
Mailing Address - Country:US
Mailing Address - Phone:201-945-5222
Mailing Address - Fax:201-945-7876
Practice Address - Street 1:101 BROAD AVE
Practice Address - Street 2:BOX 328
Practice Address - City:PALISADES PARK
Practice Address - State:NJ
Practice Address - Zip Code:07650-0328
Practice Address - Country:US
Practice Address - Phone:201-945-5222
Practice Address - Fax:201-945-7876
Is Sole Proprietor?:No
Enumeration Date:2006-06-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJD024692001223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice