Bradley David Sussner, PH.D.

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

35S100412600 Issued in NJ

Practice address

151 Knollcroft Rd BLDG 143 # 116a
Lyons, NJ 07939-5001

Phone

(908) 647-0108

Fax

(908) 604-5253

NPI assigned

Jul 28, 2006

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: No
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Philosophy

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1154044800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1740294529",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8 WASHINGTON AVE",
            "city": "WARREN",
            "state": "NJ",
            "postal_code": "070595726",
            "telephone_number": "908-561-0431"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "151 KNOLLCROFT RD BLDG 143 # 116A",
            "city": "LYONS",
            "state": "NJ",
            "postal_code": "079395001",
            "telephone_number": "908-647-0108",
            "fax_number": "908-604-5253"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SUSSNER",
        "first_name": "BRADLEY",
        "middle_name": "DAVID",
        "name_prefix": "Dr.",
        "credential": "PH.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-28",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "NJ",
            "license": "35S100412600",
            "primary": true
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "NY",
            "license": "015455",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Melanie Snider, CTRS
• Olga Bienvenida Soto-Moise, MD
• Lauren St Hill
• Melissa Rose Stellitano, DMD
• Susan K Strahs, RD,CDE
• Angela Tardanico, O.D.
• Bigy Thomas, PMHNP
• Bindhu Kanjiravilayil Thomas, M.D.
• Jan Jy-Yean Tien, PHARMD
• Laurie J. Tomaino, CTRS

• Clinical Psychologist in Lyons, NJ
• Providers in Lyons, NJ by specialty
• Clinical Psychologist in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.