Provider Demographics
NPI:1164401964
Name:RIORDAN, SUSAN JANET (MSPT)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:JANET
Last Name:RIORDAN
Suffix:
Gender:F
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 BANK RD
Mailing Address - Street 2:
Mailing Address - City:JEFFERSON VALLEY
Mailing Address - State:NY
Mailing Address - Zip Code:10535-1511
Mailing Address - Country:US
Mailing Address - Phone:914-245-8807
Mailing Address - Fax:914-245-9015
Practice Address - Street 1:600 BANK RD
Practice Address - Street 2:
Practice Address - City:JEFFERSON VALLEY
Practice Address - State:NY
Practice Address - Zip Code:10535-1511
Practice Address - Country:US
Practice Address - Phone:914-245-8807
Practice Address - Fax:914-245-9015
Is Sole Proprietor?:No
Enumeration Date:2006-01-11
Last Update Date:2011-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY00130131225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYQ27U61Medicare ID - Type UnspecifiedPROVIDER NUMBER