Healthcare Provider Details

I. General information

NPI: 1023203247
Provider Name (Legal Business Name): SUZAN S FENSTERMACHER RPA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/11/2007
Last Update Date: 12/14/2020
Certification Date: 12/14/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

88 TIOGA AVE. SUITE 102
CORNING NY
14830
US

IV. Provider business mailing address

2977 WESTINGHOUSE RD
HORSEHEADS NY
14845-8120
US

V. Phone/Fax

Practice location:
  • Phone: 607-684-6115
  • Fax: 607-684-6120
Mailing address:
  • Phone: 607-684-6115
  • Fax: 607-684-6120

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number011863
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: