Healthcare Provider Details

I. General information

NPI: 1033414255
Provider Name (Legal Business Name): AMY E SUESSLE DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/19/2011
Last Update Date: 12/03/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

349 MEETING HOUSE LN OLD TOWN MEDICAL VILLAGE
SOUTHAMPTON NY
11968-5051
US

IV. Provider business mailing address

PO BOX 1560 123 NORTH SEA ROAD -1560
SOUTHAMPTON NY
11969-1560
US

V. Phone/Fax

Practice location:
  • Phone: 631-377-3630
  • Fax:
Mailing address:
  • Phone: 631-276-2659
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code204D00000X
TaxonomyNeuromusculoskeletal Medicine & OMM Physician
License Number259627-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: