Healthcare Provider Details

I. General information

NPI: 1457367724
Provider Name (Legal Business Name): SUSAN AMICO D.P.M.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/31/2006
Last Update Date: 02/13/2022
Certification Date: 02/13/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

62 SEGUINE AVE STE 2
STATEN ISLAND NY
10309-3723
US

IV. Provider business mailing address

62 SEGUINE AVE STE 2
STATEN ISLAND NY
10309-3723
US

V. Phone/Fax

Practice location:
  • Phone: 718-317-7740
  • Fax: 718-948-1090
Mailing address:
  • Phone: 718-317-7740
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code213ES0131X
TaxonomyFoot Surgery Podiatrist
License NumberN003694
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License NumberN003694
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: