Provider Demographics
NPI:1104060367
Name:MCCADDEN, SUSAN SOBOL (PT, RN)
Entity type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:SOBOL
Last Name:MCCADDEN
Suffix:
Gender:F
Credentials:PT, RN
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Other - Last Name:
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Mailing Address - Street 1:28 CENTER ST
Mailing Address - Street 2:
Mailing Address - City:PEARL RIVER
Mailing Address - State:NY
Mailing Address - Zip Code:10965-2101
Mailing Address - Country:US
Mailing Address - Phone:845-641-6662
Mailing Address - Fax:
Practice Address - Street 1:28 CENTER ST
Practice Address - Street 2:
Practice Address - City:PEARL RIVER
Practice Address - State:NY
Practice Address - Zip Code:10965-2101
Practice Address - Country:US
Practice Address - Phone:845-641-6662
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-30
Last Update Date:2017-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY579146163W00000X
NY032791-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No163W00000XNursing Service ProvidersRegistered Nurse