MEDICARE: SUSAN BARD AUSSICKER

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	163W00000X	Registered Nurse	466494-1	NY

General Provider Information

NPI Number	:	1932355476
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SUSAN BARD AUSSICKER

Provider Business Mailing Address
First Line	:	124 MIDLINE RD
Second Line	:
City	:	BALLSTON LAKE
State	:	NY
Zip	:	12019-9525
Country	:	US
Telephone Number	:	518-309-3766
Fax Number	:

Provider Business Practice Location Address
First Line	:	124 MIDLINE RD
Second Line	:
City	:	BALLSTON LAKE
State	:	NY
Zip	:	12019-9525
Country	:	US
Telephone Number	:	518-309-3766
Fax Number	:

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

Provider Enumeration Date	:	08/15/2008
Last Update Date	:	08/25/2008

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Directions to “ SUSAN BARD AUSSICKER ” Practice Location

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