Healthcare Provider Details

I. General information

NPI: 1285609131
Provider Name (Legal Business Name): MICHAEL SUSCO M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/22/2006
Last Update Date: 03/16/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1386 HATHAWAY DR SUITE A
FARMINGTON NY
14425-8973
US

IV. Provider business mailing address

241 NORTH RD
POUGHKEEPSIE NY
12601-1154
US

V. Phone/Fax

Practice location:
  • Phone: 585-396-4190
  • Fax:
Mailing address:
  • Phone: 845-431-8853
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number168413-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: