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General NPI Number Information
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NPI Number | 1932479292
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Entity Type | Individual
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Provider Name | ANDREW D SUSENO P.T.
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Gender | Male
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Dates
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Enumeration Date | 01/04/2012
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Last Update Date | 01/08/2019
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Provider Practice Location Address
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Address Line | 186 E 111TH ST APT 2
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City | NEW YORK
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State | NY
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Zip | 10029-2840
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Country | US
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Telephone | 678-488-9727
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Fax |
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Provider Business Mailing Address
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Address Line | 186 E 111TH ST APT 2
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City | NEW YORK
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State | NY
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Zip | 10029-2840
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Country | US
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Telephone | 678-488-9727
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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 | 2251P0200X
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Taxonomy Name | Pediatric Physical Therapist
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License Number | 034617
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License Number State | NY
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