Provider Demographics
NPI:1255518171
Name:VOZILA, SUSAN MARIA (BS)
Entity type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:MARIA
Last Name:VOZILA
Suffix:
Gender:F
Credentials:BS
Other - Prefix:MS
Other - First Name:SUSAN
Other - Middle Name:MARIA
Other - Last Name:VOZILA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:BS
Mailing Address - Street 1:340 E 23RD ST
Mailing Address - Street 2:APT 4 H
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10010-4744
Mailing Address - Country:US
Mailing Address - Phone:917-304-2706
Mailing Address - Fax:
Practice Address - Street 1:205 8TH AVE
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10011-1617
Practice Address - Country:US
Practice Address - Phone:212-691-9050
Practice Address - Fax:212-691-9052
Is Sole Proprietor?:No
Enumeration Date:2008-01-22
Last Update Date:2015-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY048621-1183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01237847Medicaid