Healthcare Provider Details

I. General information

NPI: 1356383392
Provider Name (Legal Business Name): SUSAN M WATSON N.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/12/2006
Last Update Date: 03/17/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

UNIVERSITY HOSPITAL, L5
STONY BROOK NY
11794-0001
US

IV. Provider business mailing address

PO BOX 1559
STONY BROOK NY
11790-0989
US

V. Phone/Fax

Practice location:
  • Phone: 631-444-8211
  • Fax:
Mailing address:
  • Phone: 631-444-8211
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0200X
TaxonomyPediatric Registered Nurse
License NumberF381107
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: