MEDICARE: SUSAN AIKEN NPP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363L00000X	Nurse Practitioner	00400788	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1043362239
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SUSAN AIKEN NPP

Provider Business Mailing Address
First Line	:	49 HIGGINS ST
Second Line	:
City	:	NORTH BABYLON
State	:	NY
Zip	:	11703-3505
Country	:	US
Telephone Number	:	631-665-6707
Fax Number	:

Provider Business Practice Location Address
First Line	:	9 4TH AVE
Second Line	:
City	:	BAY SHORE
State	:	NY
Zip	:	11706-7908
Country	:	US
Telephone Number	:	631-665-6707
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/17/2007
Last Update Date	:	04/10/2012

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