Provider Demographics
NPI:1053364489
Name:ROELOFFS, SUSAN ANN (MD)
Entity type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:ANN
Last Name:ROELOFFS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:HIGHLAND AVE
Mailing Address - Street 2:P. O. BOX 339
Mailing Address - City:PEAPACK
Mailing Address - State:NJ
Mailing Address - Zip Code:07977-0339
Mailing Address - Country:US
Mailing Address - Phone:908-234-0011
Mailing Address - Fax:908-234-2635
Practice Address - Street 1:HIGHLAND AVE
Practice Address - Street 2:
Practice Address - City:PEAPACK
Practice Address - State:NJ
Practice Address - Zip Code:07977-0339
Practice Address - Country:US
Practice Address - Phone:908-234-0011
Practice Address - Fax:908-234-2635
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA064746002080P0008X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0008XAllopathic & Osteopathic PhysiciansPediatricsNeurodevelopmental Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ8854203Medicaid