Provider Demographics
NPI:1447352364
Name:SHENK, SUZANNE H (DO)
Entity type:Individual
Prefix:DR
First Name:SUZANNE
Middle Name:H
Last Name:SHENK
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 LIPPINCOTT DR STE 410
Mailing Address - Street 2:
Mailing Address - City:MARLTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08053-4197
Mailing Address - Country:US
Mailing Address - Phone:565-667-0708
Mailing Address - Fax:856-566-7002
Practice Address - Street 1:42 E LAUREL RD STE 3100-A
Practice Address - Street 2:
Practice Address - City:STRATFORD
Practice Address - State:NJ
Practice Address - Zip Code:08084-1354
Practice Address - Country:US
Practice Address - Phone:856-566-7070
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-01
Last Update Date:2024-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MB06177100207R00000X
NJMB61771207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ381020OtherGROUP MEDICARE
NJ0455091OtherGROUP MEDICAID
NJ381020OtherGROUP MEDICARE
NJ631627ZK8MMedicare PIN
NJ0455091OtherGROUP MEDICAID