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General NPI Number Information
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NPI Number | 1104008390
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Entity Type | Organization
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Legal Business Name | WALTER SUSSMAN MDPC & GEORGE TUNG MD
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Dates
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Enumeration Date | 11/29/2007
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Last Update Date | 03/16/2020
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Provider Practice Location Address
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Address Line | 2450 MERRICK RD
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City | BELLMORE
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State | NY
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Zip | 11710-5704
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Country | US
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Telephone | 516-783-0300
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Fax | 516-783-4048
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Provider Business Mailing Address
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Address Line | 2450 MERRICK RD
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City | BELLMORE
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State | NY
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Zip | 11710-5704
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Country | US
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Telephone | 516-783-0300
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Fax | 516-783-4048
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Authorized Official
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Title or Position | PRACTICE ADMINISTRATOR
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Name | DAVID TUNG
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Credential |
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Telephone | 516-783-0300
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number | 162044
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License Number State | NY
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