Provider Demographics
NPI:1023366945
Name:MELIKSETYAN, SUZANNA
Entity Type:Individual
Prefix:
First Name:SUZANNA
Middle Name:
Last Name:MELIKSETYAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2181 MADISON AVE
Mailing Address - Street 2:APT. 11A
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10037-2301
Mailing Address - Country:US
Mailing Address - Phone:347-708-9370
Mailing Address - Fax:347-708-9371
Practice Address - Street 1:2181 MADISON AVE
Practice Address - Street 2:APT. 11A
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10037-2301
Practice Address - Country:US
Practice Address - Phone:347-708-9370
Practice Address - Fax:347-708-9371
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-27
Last Update Date:2012-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies