Healthcare Provider Details

I. General information

NPI: 1033143391
Provider Name (Legal Business Name): SUSAN L MEKOSH P.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/10/2006
Last Update Date: 07/16/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1301 RIVER ST SUITE 204
VALATIE NY
12184-9694
US

IV. Provider business mailing address

PO BOX 2000
HUDSON NY
12534-2000
US

V. Phone/Fax

Practice location:
  • Phone: 518-758-1766
  • Fax: 518-758-1439
Mailing address:
  • Phone: 518-828-8363
  • Fax: 518-697-3388

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number007248
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: