MEDICARE: DR. DAVID JOEL SUSSMAN M.D.

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	208800000X	Urology Physician	124363	NY

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
8	442012084	OTHER	NY	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0042154	OTHER	NY	AETNA
2	25528P	OTHER	NY	HIP
3	0000712414	OTHER	NY	APWU
4	0764785	OTHER	NY	CIGNA
5	124363A-21	OTHER	NY	HEALTHFIRST
6	119892	OTHER	NY	WELLCARE
7	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
9	000000019892	OTHER	NY	GHI HMO
10	KS385	OTHER	NY	OXFORD
11	000269400101	OTHER	NY	HEALTH PLUS
12	124363 N01	OTHER	NY	HIP
13	BKX094501	OTHER	NY	AMERICHOICE
14	OC2752	OTHER	NY	HEALTHNET

General Provider Information

NPI Number	:	1164586988
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DAVID JOEL SUSSMAN M.D.

Provider Business Mailing Address
First Line	:	48 SEALY DR
Second Line	:
City	:	LAWRENCE
State	:	NY
Zip	:	11559-2420
Country	:	US
Telephone Number	:	718-783-2111
Fax Number	:	718-857-4901

Provider Business Practice Location Address
First Line	:	1 HANSON PL
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11243-2907
Country	:	US
Telephone Number	:	718-783-2111
Fax Number	:	718-857-4901

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

Provider Enumeration Date	:	12/19/2006
Last Update Date	:	01/28/2013

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