Provider Demographics
NPI:1750686069
Name:TROISE, SUSAN COFFIN (RN)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:COFFIN
Last Name:TROISE
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:88 LEONARD ST
Mailing Address - Street 2:
Mailing Address - City:WADING RIVER
Mailing Address - State:NY
Mailing Address - Zip Code:11792-1608
Mailing Address - Country:US
Mailing Address - Phone:631-929-0489
Mailing Address - Fax:
Practice Address - Street 1:88 LEONARD ST
Practice Address - Street 2:
Practice Address - City:WADING RIVER
Practice Address - State:NY
Practice Address - Zip Code:11792-1608
Practice Address - Country:US
Practice Address - Phone:631-929-0489
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-01-18
Last Update Date:2011-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY633441-1163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY633441-1Medicaid