Provider Demographics
NPI:1154413409
Name:SUSSMAN MEDICAL ASSOCIATES INC
Entity type:Organization
Organization Name:SUSSMAN MEDICAL ASSOCIATES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:SUSSMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:954-428-4800
Mailing Address - Street 1:1979 W HILLSBORO BLVD
Mailing Address - Street 2:SUITE 1
Mailing Address - City:DEERFIELD BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33442-1444
Mailing Address - Country:US
Mailing Address - Phone:954-428-4800
Mailing Address - Fax:
Practice Address - Street 1:1979 W HILLSBORO BLVD
Practice Address - Street 2:SUITE 1
Practice Address - City:DEERFIELD BEACH
Practice Address - State:FL
Practice Address - Zip Code:33442-1444
Practice Address - Country:US
Practice Address - Phone:954-428-4800
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL21804Medicare ID - Type UnspecifiedGROUP MEDICARE NUUMBER