1316298441 NPI number — MR. SUSAN MARY SOLOSKY

Table of content: MR. SUSAN MARY SOLOSKY (NPI 1316298441)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1316298441 NPI number — MR. SUSAN MARY SOLOSKY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SOLOSKY
Provider First Name:
SUSAN
Provider Middle Name:
MARY
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1316298441
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/28/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
348 HORTON HWY
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MINEOLA
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11501-1419
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
516-524-8411
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
300 GARDEN CITY PLZ
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GARDEN CITY
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11530-3302
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
516-747-9030
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/28/2012

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 174400000X , with the licence number:  083422011 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 083422011 . This is a "SPECIAL ED" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".