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General NPI Number Information
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NPI Number | 1578612420
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Entity Type | Individual
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Provider Name | MARY SUFRIN CNM
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Gender | Female
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Dates
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Enumeration Date | 01/09/2007
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Last Update Date | 09/11/2025
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Provider Practice Location Address
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Address Line | 280 N BEDFORD RD
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City | MOUNT KISCO
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State | NY
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Zip | 10549-1141
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Country | US
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Telephone | 914-666-6025
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Fax |
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Provider Business Mailing Address
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Address Line | 21 COLONIAL DR
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City | MAHOPAC
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State | NY
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Zip | 10541-1534
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Country | US
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Telephone | 845-628-5782
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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 | 363LX0001X
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Taxonomy Name | Obstetrics & Gynecology Nurse Practitioner
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License Number | F360463
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 367A00000X
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Taxonomy Name | Advanced Practice Midwife
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License Number | FOOO420
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License Number State | NY
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