Active NPI
Nolan Mathew Killip Sucdad, OTD, OTR/L
- Occupational Therapist
- Bergenfield, NJ
National Provider Identifier
1992467609
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Occupational Therapist
- License
- 21972
- Practice address
- 18 New Jersey Ave
Bergenfield, NJ 07621-1325 - Phone
- (201) 384-4257
- NPI assigned
- Oct 10, 2021
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Occupational Therapist | 225X00000X | 21972 | CA | Primary |
Addresses
Primary practice location
18 New Jersey Ave
Bergenfield, NJ 07621-1325
Mailing address
18 New Jersey Ave
Bergenfield, NJ 07621-1325
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1633824000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1633824000000",
"number": "1992467609",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "18 NEW JERSEY AVE",
"city": "BERGENFIELD",
"state": "NJ",
"postal_code": "076211325"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "18 NEW JERSEY AVE",
"city": "BERGENFIELD",
"state": "NJ",
"postal_code": "076211325",
"telephone_number": "201-384-4257"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SUCDAD",
"first_name": "NOLAN MATHEW",
"middle_name": "KILLIP",
"credential": "OTD, OTR/L",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2021-10-10",
"last_updated": "2021-10-10",
"certification_date": "2021-10-10",
"status": "A"
},
"taxonomies": [
{
"code": "225X00000X",
"taxonomy_group": "",
"desc": "Occupational Therapist",
"state": "CA",
"license": "21972",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Bergenfield, NJ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 10, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.