Provider Demographics
NPI:1619932399
Name:PERKINS, SUSAN M (NP, CASAC)
Entity Type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:M
Last Name:PERKINS
Suffix:
Gender:F
Credentials:NP, CASAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2345 ROUTE 52
Mailing Address - Street 2:SUITE F
Mailing Address - City:HOPEWELL JUNCTION
Mailing Address - State:NY
Mailing Address - Zip Code:12533-3218
Mailing Address - Country:US
Mailing Address - Phone:845-797-2318
Mailing Address - Fax:888-972-5017
Practice Address - Street 1:2345 ROUTE 52
Practice Address - Street 2:SUITE F
Practice Address - City:HOPEWELL JUNCTION
Practice Address - State:NY
Practice Address - Zip Code:12533-3218
Practice Address - Country:US
Practice Address - Phone:845-797-2318
Practice Address - Fax:888-972-5017
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-18
Last Update Date:2016-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF303543-1363LA2200X
NYF400830-1363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY0312G1Medicare ID - Type Unspecified