Provider Demographics
NPI:1780807388
Name:SUSI, ANDREW C (DC)
Entity type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:C
Last Name:SUSI
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 ISLAND PARKWAY NORTH
Mailing Address - Street 2:
Mailing Address - City:ISLAND PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11558-1302
Mailing Address - Country:US
Mailing Address - Phone:516-852-7023
Mailing Address - Fax:718-327-1156
Practice Address - Street 1:499 BEACH 20TH ST
Practice Address - Street 2:
Practice Address - City:FAR ROCKAWAY
Practice Address - State:NY
Practice Address - Zip Code:11691-3621
Practice Address - Country:US
Practice Address - Phone:718-327-5011
Practice Address - Fax:718-327-1156
Is Sole Proprietor?:No
Enumeration Date:2007-04-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX008405111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYX4R221Medicare ID - Type Unspecified