Provider Demographics
NPI:1033553888
Name:SUSI, AURORA
Entity Type:Individual
Prefix:
First Name:AURORA
Middle Name:
Last Name:SUSI
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 1:25 WESTCHESTER SQ
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10461-3545
Mailing Address - Country:US
Mailing Address - Phone:718-597-6162
Mailing Address - Fax:718-597-6168
Practice Address - Street 1:25 WESTCHESTER SQ
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10461-3545
Practice Address - Country:US
Practice Address - Phone:718-597-6162
Practice Address - Fax:718-597-6168
Is Sole Proprietor?:No
Enumeration Date:2013-04-23
Last Update Date:2013-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY007390156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician