Provider Demographics
NPI:1649674854
Name:RIETH, SUSANNE
Entity type:Individual
Prefix:
First Name:SUSANNE
Middle Name:
Last Name:RIETH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21636 ROCKAWAY POINT BLVD
Mailing Address - Street 2:
Mailing Address - City:BREEZY POINT
Mailing Address - State:NY
Mailing Address - Zip Code:11697-1127
Mailing Address - Country:US
Mailing Address - Phone:917-567-1144
Mailing Address - Fax:
Practice Address - Street 1:21636 ROCKAWAY POINT BLVD
Practice Address - Street 2:
Practice Address - City:BREEZY POINT
Practice Address - State:NY
Practice Address - Zip Code:11697-1127
Practice Address - Country:US
Practice Address - Phone:917-567-1144
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-17
Last Update Date:2014-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY519792111252Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency