Provider Demographics
NPI:1639587652
Name:CHRISTINA M. SUOZZO NP PSYCHIATRY PC
Entity Type:Organization
Organization Name:CHRISTINA M. SUOZZO NP PSYCHIATRY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:DEBRA
Authorized Official - Middle Name:
Authorized Official - Last Name:COANE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:631-681-4754
Mailing Address - Street 1:475 E MAIN ST
Mailing Address - Street 2:SUITE 211
Mailing Address - City:PATCHOGUE
Mailing Address - State:NY
Mailing Address - Zip Code:11772-3121
Mailing Address - Country:US
Mailing Address - Phone:631-569-4646
Mailing Address - Fax:631-893-4020
Practice Address - Street 1:475 E MAIN ST
Practice Address - Street 2:SUITE 211
Practice Address - City:PATCHOGUE
Practice Address - State:NY
Practice Address - Zip Code:11772-3121
Practice Address - Country:US
Practice Address - Phone:631-569-4646
Practice Address - Fax:631-893-4020
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-23
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF401022163WP0807X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WP0807XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, Child & AdolescentGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY933831OtherMEDICARE PTAN
NY02931419Medicaid
NYMS1589588OtherDEA