Healthcare Provider Details

I. General information

NPI: 1710896287
Provider Name (Legal Business Name): SUSAN PUSTILNIK
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/02/2026
Last Update Date: 09/02/2026
Certification Date: 09/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

131 W 25TH ST
NEW YORK NY
10001-7243
US

IV. Provider business mailing address

40 OCEAN PKWY APT 6D
BROOKLYN NY
11218-1536
US

V. Phone/Fax

Practice location:
  • Phone: 347-350-3493
  • Fax:
Mailing address:
  • Phone: 347-350-3493
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code221700000X
TaxonomyArt Therapist
License Number000305-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: