Provider Demographics
NPI:1578592093
Name:SUSSNER, JUSTIN H (DPM)
Entity Type:Individual
Prefix:DR
First Name:JUSTIN
Middle Name:H
Last Name:SUSSNER
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:785 ROUTE 17M
Mailing Address - Street 2:SHOPRITE PLAZA
Mailing Address - City:MONROE
Mailing Address - State:NY
Mailing Address - Zip Code:10950-2623
Mailing Address - Country:US
Mailing Address - Phone:845-782-3000
Mailing Address - Fax:845-782-7751
Practice Address - Street 1:222 ROUTE 59
Practice Address - Street 2:SUITE 305
Practice Address - City:SUFFERN
Practice Address - State:NY
Practice Address - Zip Code:10901-5204
Practice Address - Country:US
Practice Address - Phone:845-368-2442
Practice Address - Fax:845-368-3775
Is Sole Proprietor?:No
Enumeration Date:2006-06-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN005955213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
U99033Medicare UPIN
NYPJ2211Medicare ID - Type Unspecified