1548483399 NPI number — MRS. SUSANNE YUNG ALLEN VII MPT

Table of content: MRS. SUSANNE YUNG ALLEN VII MPT (NPI 1548483399)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1548483399 NPI number — MRS. SUSANNE YUNG ALLEN VII MPT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ALLEN
Provider First Name:
SUSANNE
Provider Middle Name:
YUNG
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
VII
Provider Credential Text:
MPT
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:
1548483399
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
31 JEREMY CIR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NESCONSET
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11767-2941
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
516-236-0638
Provider Business Mailing Address Fax Number:
641-577-3409

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1895 WALT WHITMAN RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MELVILLE
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11747-3031
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
631-577-3400
Provider Business Practice Location Address Fax Number:
631-577-3409
Provider Enumeration Date:
04/10/2007

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: 225100000X , with the licence number:  027190-1 , 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)





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