Provider Demographics
NPI:1518946300
Name:SUSSMAN, HOWARD (MD)
Entity Type:Individual
Prefix:DR
First Name:HOWARD
Middle Name:
Last Name:SUSSMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4295 HEMPSTEAD TPKE
Mailing Address - Street 2:
Mailing Address - City:BETHPAGE
Mailing Address - State:NY
Mailing Address - Zip Code:11714-5713
Mailing Address - Country:US
Mailing Address - Phone:516-520-2780
Mailing Address - Fax:516-520-2778
Practice Address - Street 1:4295 HEMPSTEAD TPKE
Practice Address - Street 2:
Practice Address - City:BETHPAGE
Practice Address - State:NY
Practice Address - Zip Code:11714-5713
Practice Address - Country:US
Practice Address - Phone:516-520-2780
Practice Address - Fax:516-520-2778
Is Sole Proprietor?:No
Enumeration Date:2006-01-11
Last Update Date:2012-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY168699208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY0042235OtherGHI
NY4102OtherVYTRA
NY4266129OtherAETNAUSHC
NYAS403OtherOXFORD HEALTH PLANS
NYOC3105OtherHEALTHNET
NY6524287-013OtherCIGNA
NY29221POtherHIP
NY01835634Medicaid
NY07F951OtherBLUE CROSS/BLUE SHEILD
NYE87226Medicare UPIN
NY29221POtherHIP
NY07F951Medicare PIN