Provider Demographics
NPI:1982864906
Name:CHERIAN, SUSAN JACOB (NP)
Entity Type:Individual
Prefix:PROF
First Name:SUSAN
Middle Name:JACOB
Last Name:CHERIAN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8 CLAUDIA CT
Mailing Address - Street 2:
Mailing Address - City:TAPPAN
Mailing Address - State:NY
Mailing Address - Zip Code:10983-1936
Mailing Address - Country:US
Mailing Address - Phone:845-365-6741
Mailing Address - Fax:845-365-6741
Practice Address - Street 1:48 NEW MAIN ST
Practice Address - Street 2:
Practice Address - City:HAVERSTRAW
Practice Address - State:NY
Practice Address - Zip Code:10927-1812
Practice Address - Country:US
Practice Address - Phone:845-429-1680
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-06-12
Last Update Date:2013-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY380734363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics