Provider Demographics
NPI:1467491126
Name:YURCISIN, SUSAN E (FNP)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:E
Last Name:YURCISIN
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:MOUNT KISCO MEDICAL GROUP PC
Mailing Address - Street 2:90 SOUTH BEDFORD ROAD
Mailing Address - City:MOUNT KISCO
Mailing Address - State:NY
Mailing Address - Zip Code:10549
Mailing Address - Country:US
Mailing Address - Phone:914-241-1050
Mailing Address - Fax:
Practice Address - Street 1:MOUNT KISCO MEDICAL GROUP PC
Practice Address - Street 2:90 SOUTH BEDFORD ROAD
Practice Address - City:MOUNT KISCO
Practice Address - State:NY
Practice Address - Zip Code:10549
Practice Address - Country:US
Practice Address - Phone:914-241-1050
Practice Address - Fax:914-242-1516
Is Sole Proprietor?:No
Enumeration Date:2006-06-06
Last Update Date:2007-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF333154363LF0000X
CT003475363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02191862Medicaid
NY02191862Medicaid
NYW06761Medicare PIN
NY2E7121Medicare PIN