Healthcare Provider Details

I. General information

NPI: 1366756066
Provider Name (Legal Business Name): SUSAN J WARE MS, RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/05/2010
Last Update Date: 08/05/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16 E 40TH ST FL 12
NEW YORK NY
10016-0113
US

IV. Provider business mailing address

246 STORER AVE
NEW ROCHELLE NY
10801-3119
US

V. Phone/Fax

Practice location:
  • Phone: 212-307-7107
  • Fax: 212-307-2308
Mailing address:
  • Phone: 914-576-6198
  • Fax: 914-576-6198

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WA2000X
TaxonomyAdministrator Registered Nurse
License Number497156-1
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License Number497156-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: