Healthcare Provider Details

I. General information

NPI: 1639587652
Provider Name (Legal Business Name): CHRISTINA M. SUOZZO NP PSYCHIATRY PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/23/2014
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

475 E MAIN ST SUITE 211
PATCHOGUE NY
11772-3121
US

IV. Provider business mailing address

475 E MAIN ST SUITE 211
PATCHOGUE NY
11772-3121
US

V. Phone/Fax

Practice location:
  • Phone: 631-569-4646
  • Fax: 631-893-4020
Mailing address:
  • Phone: 631-569-4646
  • Fax: 631-893-4020

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0807X
TaxonomyChild & Adolescent Psychiatric/Mental Health Registered Nurse
License NumberF401022
License Number StateNY

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier933831
Identifier TypeOTHER
Identifier StateNY
Identifier IssuerMEDICARE PTAN
# 2
Identifier02931419
Identifier TypeMEDICAID
Identifier StateNY
Identifier Issuer

VIII. Authorized Official

Name: MRS. DEBRA COANE
Title or Position: OFFICE MANAGER
Credential:
Phone: 631-681-4754