Provider Demographics
NPI:1275511826
Name:SUSS, AMY L (MD)
Entity Type:Individual
Prefix:DR
First Name:AMY
Middle Name:L
Last Name:SUSS
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:450 CLARKSON AVE
Mailing Address - Street 2:BOX 49
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11203-2056
Mailing Address - Country:US
Mailing Address - Phone:718-270-1006
Mailing Address - Fax:718-270-1985
Practice Address - Street 1:450 CLARKSON AVE
Practice Address - Street 2:BOX 49
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11203-2056
Practice Address - Country:US
Practice Address - Phone:718-270-1006
Practice Address - Fax:718-270-1985
Is Sole Proprietor?:No
Enumeration Date:2006-01-04
Last Update Date:2022-02-03
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Provider Licenses
StateLicense IDTaxonomies
NY179617-12080A0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01879083Medicare UPIN