Provider Demographics
NPI:1932339314
Name:SUSSMAN, BARBARA (FNP)
Entity Type:Individual
Prefix:MS
First Name:BARBARA
Middle Name:
Last Name:SUSSMAN
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:821 BAY 25TH ST
Mailing Address - Street 2:
Mailing Address - City:FAR ROCKAWAY
Mailing Address - State:NY
Mailing Address - Zip Code:11691-1800
Mailing Address - Country:US
Mailing Address - Phone:718-337-6650
Mailing Address - Fax:718-337-6653
Practice Address - Street 1:821 BAY 25TH ST
Practice Address - Street 2:
Practice Address - City:FAR ROCKAWAY
Practice Address - State:NY
Practice Address - Zip Code:11691-1800
Practice Address - Country:US
Practice Address - Phone:718-337-6650
Practice Address - Fax:718-337-6653
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-21
Last Update Date:2009-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY330099363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily