Healthcare Provider Details

I. General information

NPI: 1619932399
Provider Name (Legal Business Name): SUSAN M. PERKINS NP, CASAC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/18/2006
Last Update Date: 08/19/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2345 ROUTE 52 SUITE F
HOPEWELL JUNCTION NY
12533-3218
US

IV. Provider business mailing address

2345 ROUTE 52 SUITE F
HOPEWELL JUNCTION NY
12533-3218
US

V. Phone/Fax

Practice location:
  • Phone: 845-797-2318
  • Fax: 888-972-5017
Mailing address:
  • Phone: 845-797-2318
  • Fax: 888-972-5017

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberF303543-1
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberF400830-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: