Provider Demographics
NPI:1821394701
Name:SUSTUS, LLC
Entity Type:Organization
Organization Name:SUSTUS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JONATHAN
Authorized Official - Middle Name:MICHEAL
Authorized Official - Last Name:MASORTI
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:814-272-0420
Mailing Address - Street 1:251 EASTERLY PKWY BLDG 2
Mailing Address - Street 2:
Mailing Address - City:STATE COLLEGE
Mailing Address - State:PA
Mailing Address - Zip Code:16801-6301
Mailing Address - Country:US
Mailing Address - Phone:814-272-0420
Mailing Address - Fax:
Practice Address - Street 1:251 EASTERLY PKWY, BLDG 2
Practice Address - Street 2:
Practice Address - City:STATE COLLEGE
Practice Address - State:PA
Practice Address - Zip Code:16801-6301
Practice Address - Country:US
Practice Address - Phone:814-272-0420
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-10
Last Update Date:2011-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA003788L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty