Provider Demographics
NPI:1578612420
Name:SUFRIN, MARY (CNM)
Entity Type:Individual
Prefix:MS
First Name:MARY
Middle Name:
Last Name:SUFRIN
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21 COLONIAL DR
Mailing Address - Street 2:
Mailing Address - City:MAHOPAC
Mailing Address - State:NY
Mailing Address - Zip Code:10541-1534
Mailing Address - Country:US
Mailing Address - Phone:845-628-5782
Mailing Address - Fax:
Practice Address - Street 1:280 N BEDFORD RD
Practice Address - Street 2:
Practice Address - City:MOUNT KISCO
Practice Address - State:NY
Practice Address - Zip Code:10549-1141
Practice Address - Country:US
Practice Address - Phone:914-666-6025
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF360463363LX0001X
NYFOOO420367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology
Not Answered367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife