1659767648 NPI number — MRS. SUZANA X SULA LPN

Table of content: MRS. SUZANA X SULA LPN (NPI 1659767648)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1659767648 NPI number — MRS. SUZANA X SULA LPN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SULA
Provider First Name:
SUZANA
Provider Middle Name:
X
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
LPN
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
SULA
Provider Other First Name:
SUZANA
Provider Other Middle Name:
Provider Other Name Prefix Text:
MRS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
LPN
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1659767648
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/07/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3404 34TH AVE # APTD5
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ASTORIA
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11106-1174
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
347-255-8330
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
263 BLUE POINT
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LONG ISLAND
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11742
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
631-419-6737
Provider Business Practice Location Address Fax Number:
631-868-3498
Provider Enumeration Date:
04/07/2015

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: 164W00000X , with the licence number:  319892 , 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: 319892 . This is a "THE UNIVERSITY OF THE STATE OF NY. EDUCATION DEPARTMENT" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".