Healthcare Provider Details

I. General information

NPI: 1427491638
Provider Name (Legal Business Name): SUSAN M PENDERS RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/08/2013
Last Update Date: 04/08/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25 LITTLE PLAINS RD
HUNTINGTON NY
11743-4550
US

IV. Provider business mailing address

25 LITTLE PLAINS RD
HUNTINGTON NY
11743-4550
US

V. Phone/Fax

Practice location:
  • Phone: 631-266-4409
  • Fax: 631-923-1955
Mailing address:
  • Phone: 631-266-4409
  • Fax: 631-923-1955

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WS0200X
TaxonomySchool Registered Nurse
License Number396124-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: