Provider Demographics
NPI:1619686797
Name:DUSSEK, TERRY
Entity Type:Individual
Prefix:
First Name:TERRY
Middle Name:
Last Name:DUSSEK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14333 SANFORD AVE APT A1
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11355-2021
Mailing Address - Country:US
Mailing Address - Phone:646-391-6591
Mailing Address - Fax:
Practice Address - Street 1:10818 QUEENS BLVD STE 4A
Practice Address - Street 2:
Practice Address - City:FOREST HILLS
Practice Address - State:NY
Practice Address - Zip Code:11375-4748
Practice Address - Country:US
Practice Address - Phone:212-804-7659
Practice Address - Fax:888-975-7704
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-17
Last Update Date:2022-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY461882750OtherSERVICE COORDINATOR