Provider Demographics
NPI:1285003681
Name:SUSSKIND, SHIMON
Entity Type:Individual
Prefix:
First Name:SHIMON
Middle Name:
Last Name:SUSSKIND
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:425 KINGS HWY
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11223-1629
Mailing Address - Country:US
Mailing Address - Phone:718-787-1100
Mailing Address - Fax:
Practice Address - Street 1:425 KINGS HWY
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11223-1629
Practice Address - Country:US
Practice Address - Phone:718-787-1100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-09-16
Last Update Date:2015-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker