=====================================================
General NPI Number Information
=====================================================
NPI Number | 1528314192
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SUSAN M GRIFFING FNP-C PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/01/2012
-----------------------------------------------------
Last Update Date | 08/01/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4290 MIDDLE SETTLEMENT RD
-----------------------------------------------------
City | NEW HARTFORD
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 13413-5314
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 315-525-0094
-----------------------------------------------------
Fax | 315-737-0277
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4290 MIDDLE SETTLEMENT RD
-----------------------------------------------------
City | NEW HARTFORD
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 13413-5314
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 315-525-0094
-----------------------------------------------------
Fax | 315-737-0277
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | SUSAN M GRIFFING
-----------------------------------------------------
Credential | FNP-C
-----------------------------------------------------
Telephone | 315-525-0094
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number | 332020
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------