Provider Demographics
NPI:1164586988
Name:SUSSMAN, DAVID JOEL (MD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:JOEL
Last Name:SUSSMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:48 SEALY DR
Mailing Address - Street 2:
Mailing Address - City:LAWRENCE
Mailing Address - State:NY
Mailing Address - Zip Code:11559-2420
Mailing Address - Country:US
Mailing Address - Phone:718-783-2111
Mailing Address - Fax:718-857-4901
Practice Address - Street 1:1 HANSON PL
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11243-2907
Practice Address - Country:US
Practice Address - Phone:718-783-2111
Practice Address - Fax:718-857-4901
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-19
Last Update Date:2013-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY124363208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY0042154OtherAETNA
NY25528POtherHIP
NY0000712414OtherAPWU
NY0764785OtherCIGNA
NY124363A-21OtherHEALTHFIRST
NY119892OtherWELLCARE
NY00291649Medicaid
NY442012084OtherRAILROAD MEDICARE
NY000000019892OtherGHI HMO
NYKS385OtherOXFORD
NY000269400101OtherHEALTH PLUS
NY124363 N01OtherHIP
NYBKX094501OtherAMERICHOICE
NYOC2752OtherHEALTHNET
NY25528POtherHIP
NYC12395Medicare UPIN