Provider Demographics
NPI:1750788006
Name:SUSSNER, ORSOLYA VIZI (PTA)
Entity type:Individual
Prefix:
First Name:ORSOLYA
Middle Name:VIZI
Last Name:SUSSNER
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:281 HERITAGE LN
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:NY
Mailing Address - Zip Code:10950-5141
Mailing Address - Country:US
Mailing Address - Phone:845-510-4056
Mailing Address - Fax:
Practice Address - Street 1:40 PARK LN
Practice Address - Street 2:
Practice Address - City:HIGHLAND
Practice Address - State:NY
Practice Address - Zip Code:12528-2824
Practice Address - Country:US
Practice Address - Phone:845-883-5151
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-12-02
Last Update Date:2014-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY009631-1225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant