Provider Demographics
NPI:1578567046
Name:FRIESS, SUSAN S (MA)
Entity Type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:S
Last Name:FRIESS
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2500 JOHNSON AVE
Mailing Address - Street 2:
Mailing Address - City:RIVERDALE
Mailing Address - State:NY
Mailing Address - Zip Code:10463-4925
Mailing Address - Country:US
Mailing Address - Phone:718-884-7252
Mailing Address - Fax:
Practice Address - Street 1:120 W 106TH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10025-3712
Practice Address - Country:US
Practice Address - Phone:212-870-5747
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-06-11
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY000064231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY000064OtherNYS LICENSE #
NYM00571Medicare UPIN