MEDICARE: MRS. SUZANNE MARIE RIGGS

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	252Y00000X	Early Intervention Provider Agency	PENDING	NY

General Provider Information

NPI Number	:	1831332337
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. SUZANNE MARIE RIGGS

Provider Business Mailing Address
First Line	:	14116 CRONSTON AVE
Second Line	:
City	:	NEPONSIT
State	:	NY
Zip	:	11694-1120
Country	:	US
Telephone Number	:	718-634-0312
Fax Number	:	718-474-2368

Provider Business Practice Location Address
First Line	:	14116 CRONSTON AVE
Second Line	:
City	:	NEPONSIT
State	:	NY
Zip	:	11694-1120
Country	:	US
Telephone Number	:	718-634-0312
Fax Number	:	718-474-2368

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

Provider Enumeration Date	:	04/13/2009
Last Update Date	:	04/13/2009

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