Provider Demographics
NPI:1275634347
Name:RHONA S SUSSER M D P C
Entity Type:Organization
Organization Name:RHONA S SUSSER M D P C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RHONA
Authorized Official - Middle Name:S
Authorized Official - Last Name:SUSSER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:516-794-7079
Mailing Address - Street 1:30 MERRICK AVE
Mailing Address - Street 2:SUITE 112
Mailing Address - City:EAST MEADOW
Mailing Address - State:NY
Mailing Address - Zip Code:11554-1579
Mailing Address - Country:US
Mailing Address - Phone:516-794-7079
Mailing Address - Fax:516-794-7033
Practice Address - Street 1:30 MERRICK AVE
Practice Address - Street 2:SUITE 112
Practice Address - City:EAST MEADOW
Practice Address - State:NY
Practice Address - Zip Code:11554-1579
Practice Address - Country:US
Practice Address - Phone:516-794-7079
Practice Address - Fax:516-794-7033
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-25
Last Update Date:2011-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY2K4331Medicare ID - Type Unspecified
NYG18792Medicare UPIN