1720171374 NPI number — NORHERN BOULEVARD NEUROLOGICAL SURGERY, P.C.

Table of content: DR. REBECCA GUESS SUSONG MD, MPH (NPI 1750694956)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1720171374 NPI number — NORHERN BOULEVARD NEUROLOGICAL SURGERY, P.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NORHERN BOULEVARD NEUROLOGICAL SURGERY, P.C.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1720171374
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
600 NORTHERN BOULEVARD
Provider Second Line Business Mailing Address:
SUITE 117
Provider Business Mailing Address City Name:
GREAT NECK
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11021
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
516-478-0004
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
600 NORTHERN BOULEVARD
Provider Second Line Business Practice Location Address:
SUITE 117
Provider Business Practice Location Address City Name:
GREAT NECK
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11021
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
516-478-0004
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/02/2006

Additional Information

Authorized Official

Authorized Official Last Name:
THOMAS-JACKSON
Authorized Official First Name:
ZORINA
Authorized Official Middle Name:
R
Authorized Official Title or Position:
BILLING/CLAIMS MANAGER
Authorized Official Telephone Number:
516-255-6228

Provider Taxonomy Codes

  • Taxonomy code: 174400000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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