Healthcare Provider Details

I. General information

NPI: 1588341457
Provider Name (Legal Business Name): AVITAL SUISSA NP, MSN-RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/30/2023
Last Update Date: 12/09/2025
Certification Date: 12/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

81 W 115TH ST
NEW YORK NY
10026-3138
US

IV. Provider business mailing address

60 MADISON AVE FL 5
NEW YORK NY
10010-1600
US

V. Phone/Fax

Practice location:
  • Phone: 212-426-0088
  • Fax: 212-426-8367
Mailing address:
  • Phone: 212-545-2400
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number352083
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: