Provider Demographics
NPI:1467543298
Name:NOLL, SUSAN MARIE (NP)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:MARIE
Last Name:NOLL
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
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Mailing Address - Street 1:3001 EXPRESSWAY DR N
Mailing Address - Street 2:112
Mailing Address - City:ISLANDIA
Mailing Address - State:NY
Mailing Address - Zip Code:11749-5301
Mailing Address - Country:US
Mailing Address - Phone:631-435-4322
Mailing Address - Fax:631-435-3423
Practice Address - Street 1:3001 EXPRESSWAY DR N
Practice Address - Street 2:112
Practice Address - City:ISLANDIA
Practice Address - State:NY
Practice Address - Zip Code:11749-5301
Practice Address - Country:US
Practice Address - Phone:631-435-4322
Practice Address - Fax:631-435-3423
Is Sole Proprietor?:No
Enumeration Date:2006-09-27
Last Update Date:2016-04-11
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NYF360052363LX0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02001581Medicaid
NYS77725Medicare UPIN
NY02001581Medicaid