Healthcare Provider Details

I. General information

NPI: 1891215695
Provider Name (Legal Business Name): SUJA THOMAS EAPEN NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/22/2017
Last Update Date: 06/22/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 PENN PLZ
NEW YORK NY
10119-0002
US

IV. Provider business mailing address

24 ROUNDTREE CIR
PIERMONT NY
10968-4213
US

V. Phone/Fax

Practice location:
  • Phone: 212-216-6791
  • Fax:
Mailing address:
  • Phone: 845-613-0153
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberF308197
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: