Provider Demographics
NPI:1679006936
Name:DR ALBIN SUSEK
Entity Type:Organization
Organization Name:DR ALBIN SUSEK
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ALBIN
Authorized Official - Middle Name:F
Authorized Official - Last Name:SUSEK
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:570-735-4005
Mailing Address - Street 1:824 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:NANTICOKE
Mailing Address - State:PA
Mailing Address - Zip Code:18634-1832
Mailing Address - Country:US
Mailing Address - Phone:570-735-4005
Mailing Address - Fax:570-735-4005
Practice Address - Street 1:824 E MAIN ST
Practice Address - Street 2:
Practice Address - City:NANTICOKE
Practice Address - State:PA
Practice Address - Zip Code:18634-1832
Practice Address - Country:US
Practice Address - Phone:570-735-4005
Practice Address - Fax:570-735-4005
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-04
Last Update Date:2017-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS019274L122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty