Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204D00000X | Neuromusculoskeletal Medicine (NMM) | 259627-1 | NY |
NPI | 1033414255 |
---|---|
Provider Name | Dr. Amy E Suessle |
First Address | Southampton, NY 11969-1560 |
Second Address | Southampton, NY 11968-5051 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/01/2011 |
Last Update Date | 03/12/2014 |