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General NPI Number Information
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NPI Number | 1720153570
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Entity Type | Individual
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Provider Name | SCOTT EVAN SUSSMAN FNP-C
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Gender | Male
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Dates
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Enumeration Date | 11/21/2006
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Last Update Date | 06/02/2025
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Provider Practice Location Address
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Address Line | 2500 NESCONSET HWY BLDG 2
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City | STONY BROOK
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State | NY
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Zip | 11790
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Country | US
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Telephone | 631-686-1414
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Fax | 631-854-9675
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Provider Business Mailing Address
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Address Line | 2500 NESCONSET HWY BLDG 2
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City | STONY BROOK
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State | NY
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Zip | 11790-2555
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Country | US
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Telephone | 631-686-1414
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Fax | 631-585-4967
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | F334083
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License Number State | NY
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