Provider Demographics
NPI:1972915387
Name:KONTAK, SUZANNE MARGARET (PMHNP-BC, ANP-C, RN)
Entity Type:Individual
Prefix:MRS
First Name:SUZANNE
Middle Name:MARGARET
Last Name:KONTAK
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Gender:F
Credentials:PMHNP-BC, ANP-C, RN
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Mailing Address - Street 1:939 JOHNSON AVE
Mailing Address - Street 2:
Mailing Address - City:RONKONKOMA
Mailing Address - State:NY
Mailing Address - Zip Code:11779-6066
Mailing Address - Country:US
Mailing Address - Phone:631-471-7242
Mailing Address - Fax:631-471-5150
Practice Address - Street 1:939 JOHNSON AVE
Practice Address - Street 2:
Practice Address - City:RONKONKOMA
Practice Address - State:NY
Practice Address - Zip Code:11779-6066
Practice Address - Country:US
Practice Address - Phone:631-471-7242
Practice Address - Fax:631-471-5150
Is Sole Proprietor?:No
Enumeration Date:2014-05-20
Last Update Date:2020-01-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NYF306884-1363LA2200X
NYF402191-1363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health