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General NPI Number Information
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NPI Number | 1033414255
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Entity Type | Individual
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Provider Name | AMY E SUESSLE DO
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Gender | Female
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Dates
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Enumeration Date | 01/19/2011
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Last Update Date | 12/03/2014
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Provider Practice Location Address
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Address Line | 349 MEETING HOUSE LN OLD TOWN MEDICAL VILLAGE
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City | SOUTHAMPTON
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State | NY
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Zip | 11968-5051
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Country | US
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Telephone | 631-377-3630
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 1560 123 NORTH SEA ROAD -1560
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City | SOUTHAMPTON
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State | NY
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Zip | 11969-1560
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Country | US
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Telephone | 631-276-2659
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 204D00000X
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Taxonomy Name | Neuromusculoskeletal Medicine & OMM Physician
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License Number | 259627-1
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License Number State | NY
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