1356476014 NPI number — MS. KAREN AMY SUSSMAN M.A., CCC

Table of content: MS. KAREN AMY SUSSMAN M.A., CCC (NPI 1356476014)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1356476014 NPI number — MS. KAREN AMY SUSSMAN M.A., CCC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SUSSMAN
Provider First Name:
KAREN
Provider Middle Name:
AMY
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
M.A., CCC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
SUSSMAN-GOLDSTEIN
Provider Other First Name:
KAREN
Provider Other Middle Name:
AMY
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
M.A., CCC
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1356476014
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:
184 W NICHOLAI ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HICKSVILLE
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11801-3828
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
516-433-1822
Provider Business Mailing Address Fax Number:
516-433-1840

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
184 W NICHOLAI ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HICKSVILLE
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11801-3828
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
516-433-1822
Provider Business Practice Location Address Fax Number:
516-433-1840
Provider Enumeration Date:
02/22/2007

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: 235Z00000X , with the licence number:  003259-1 , 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)

  • Identifier: 112760147 . This is a "TAX ID #" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".