Provider Demographics
NPI:1821363516
Name:MCCORMACK, SUSAN (RN)
Entity type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:
Last Name:MCCORMACK
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2360 BENSON AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11214-4336
Mailing Address - Country:US
Mailing Address - Phone:718-372-3480
Mailing Address - Fax:718-333-7875
Practice Address - Street 1:2360 BENSON AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11214-4336
Practice Address - Country:US
Practice Address - Phone:718-372-3480
Practice Address - Fax:718-333-7875
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-14
Last Update Date:2012-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY446000-1163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse