Provider Demographics
NPI:1346437183
Name:SUSSER, RHONA S (MD)
Entity Type:Individual
Prefix:DR
First Name:RHONA
Middle Name:S
Last Name:SUSSER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 MERRICK AVE
Mailing Address - Street 2:
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:
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
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-25
Last Update Date:2007-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY192872207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY2K4331Medicare PIN
NYG18792Medicare UPIN