Provider Demographics
NPI:1033472907
Name:GRABER, SUSAN M (MS)
Entity Type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:M
Last Name:GRABER
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2859 SAW MILL RD
Mailing Address - Street 2:
Mailing Address - City:WANTAGH
Mailing Address - State:NY
Mailing Address - Zip Code:11793-2348
Mailing Address - Country:US
Mailing Address - Phone:516-456-9709
Mailing Address - Fax:
Practice Address - Street 1:2859 SAW MILL RD
Practice Address - Street 2:
Practice Address - City:WANTAGH
Practice Address - State:NY
Practice Address - Zip Code:11793-2348
Practice Address - Country:US
Practice Address - Phone:516-456-9709
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-16
Last Update Date:2012-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY961717001174400000X
NY961718001174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist