Provider Demographics
NPI:1942216999
Name:DECKER, SUSAN C (NPP)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:C
Last Name:DECKER
Suffix:
Gender:F
Credentials:NPP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:401 GEYSER RD
Mailing Address - Street 2:BICK WANCK MD & ASSOCIATES
Mailing Address - City:SARATOGA SPRINGS
Mailing Address - State:NY
Mailing Address - Zip Code:12866-9069
Mailing Address - Country:US
Mailing Address - Phone:518-583-3035
Mailing Address - Fax:518-583-4247
Practice Address - Street 1:401 GEYSER RD
Practice Address - Street 2:BICK WANCK MD & ASSOCIATES
Practice Address - City:SARATOGA SPRINGS
Practice Address - State:NY
Practice Address - Zip Code:12866-9069
Practice Address - Country:US
Practice Address - Phone:518-583-3035
Practice Address - Fax:518-583-4247
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF400647-1363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYF400647-1OtherNURSE PRACTITIONER, PSYCH
DD5933Medicare ID - Type Unspecified
NYF400647-1OtherNURSE PRACTITIONER, PSYCH