Provider Demographics
NPI:1578881389
Name:HOYLE, SUSAN CARRIE (805860)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:CARRIE
Last Name:HOYLE
Suffix:
Gender:F
Credentials:805860
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:75 EDMUND ST
Mailing Address - Street 2:
Mailing Address - City:LYNBROOK
Mailing Address - State:NY
Mailing Address - Zip Code:11563-1824
Mailing Address - Country:US
Mailing Address - Phone:516-816-2555
Mailing Address - Fax:
Practice Address - Street 1:75 EDMUND ST
Practice Address - Street 2:
Practice Address - City:LYNBROOK
Practice Address - State:NY
Practice Address - Zip Code:11563-1824
Practice Address - Country:US
Practice Address - Phone:515-816-2555
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-05
Last Update Date:2010-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY48 000148133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY48 000148OtherCERTIFIED DITITIAN NUTRITIONIST