Provider Demographics
NPI:1255516084
Name:SUSAN L. CECERE, M.D., LLC
Entity type:Organization
Organization Name:SUSAN L. CECERE, M.D., LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/SOLE PROPRIETOR
Authorized Official - Prefix:
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:L
Authorized Official - Last Name:CECERE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:973-495-3299
Mailing Address - Street 1:60 GORDON RD
Mailing Address - Street 2:
Mailing Address - City:ESSEX FELLS
Mailing Address - State:NJ
Mailing Address - Zip Code:07021-1604
Mailing Address - Country:US
Mailing Address - Phone:973-495-3299
Mailing Address - Fax:973-228-4790
Practice Address - Street 1:60 GORDON RD
Practice Address - Street 2:
Practice Address - City:ESSEX FELLS
Practice Address - State:NJ
Practice Address - Zip Code:07021-1604
Practice Address - Country:US
Practice Address - Phone:973-495-3299
Practice Address - Fax:973-228-4790
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-28
Last Update Date:2011-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA060419208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty