Provider Demographics
NPI:1386814572
Name:JOSEPH, SUSAN M (PA)
Entity Type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:M
Last Name:JOSEPH
Suffix:
Gender:F
Credentials:PA
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Mailing Address - Street 1:3085 HARLEM ROAD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:CHEEKTOWAGA
Mailing Address - State:NY
Mailing Address - Zip Code:14225-2591
Mailing Address - Country:US
Mailing Address - Phone:716-844-5000
Mailing Address - Fax:716-844-5050
Practice Address - Street 1:3085 HARLEM ROAD
Practice Address - Street 2:SUITE 200
Practice Address - City:CHEEKTOWAGA
Practice Address - State:NY
Practice Address - Zip Code:14225-2591
Practice Address - Country:US
Practice Address - Phone:716-844-5000
Practice Address - Fax:716-844-5050
Is Sole Proprietor?:No
Enumeration Date:2008-03-04
Last Update Date:2011-03-09
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY012413-1363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
9515172OtherINDEPENDENT HEALTH
P00773791OtherRAILROAD MEDICARE
005304444001OtherBLUE CROSS
NY03055158Medicaid
00028442001OtherUNIVERA
P00773791OtherRAILROAD MEDICARE