Provider Demographics
NPI:1356016000
Name:OSSENTJUK, SUSANNE (RN)
Entity Type:Individual
Prefix:MS
First Name:SUSANNE
Middle Name:
Last Name:OSSENTJUK
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17 RIDGE ROAD
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:NY
Mailing Address - Zip Code:12549-2708
Mailing Address - Country:US
Mailing Address - Phone:845-541-1856
Mailing Address - Fax:845-567-6357
Practice Address - Street 1:17 RIDGE ROAD
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:NY
Practice Address - Zip Code:12549-2708
Practice Address - Country:US
Practice Address - Phone:845-541-1856
Practice Address - Fax:845-567-6357
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-14
Last Update Date:2021-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY412854-1163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse