Suzanne W Botrous, M.D.

Primary specialty

Primary Care Clinic/CenterTaxonomy code 261QP2300X

License

MA061272 Issued in NJ

Practice address

185 Central Ave Ste 308
East Orange, NJ 07018-3318

Phone

(973) 678-3776

Fax

(973) 678-6065

NPI assigned

Dec 29, 2006

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Mediterranean M.D. P.a.

  • Point of Service
  • East Orange, NJ
  • NPI 1831320803
  NPD (past) Authorized official

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

{
    "created_epoch": "1167350400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1992861116",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "185 CENTRAL AVE STE 308",
            "city": "EAST ORANGE",
            "state": "NJ",
            "postal_code": "070183318",
            "telephone_number": "973-678-3776",
            "fax_number": "973-678-6065"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "185 CENTRAL AVE STE 308",
            "city": "EAST ORANGE",
            "state": "NJ",
            "postal_code": "070183318",
            "telephone_number": "973-678-3776",
            "fax_number": "973-678-6065"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOTROUS",
        "first_name": "SUZANNE",
        "middle_name": "W",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-12-29",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": "NJ",
            "license": "MA061272",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "6381006",
            "state": "NJ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Alexis Bolivar, M.A. CCC-SLP
• Maria C Bongiovanni, RD
• Maame Bonsu, APN
• Fernando Sayo Borromeo, PT
• Dwight Bostic Jr.
• Joachim S Bottoms
• Vanessa Verlinger Boucher, MSED
• Jessica Bowen
• Ramonita Bracy
• Jada Crystal Bradberry, LMSW

• Primary Care Clinic/Center in East Orange, NJ
• Providers in East Orange, NJ by specialty
• Primary Care Clinic/Center 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.