Provider Demographics
NPI:1316054760
Name:SUSSNER, BARRY (DPM)
Entity type:Individual
Prefix:DR
First Name:BARRY
Middle Name:
Last Name:SUSSNER
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:222 ROUTE 59
Mailing Address - Street 2:SUITE 305
Mailing Address - City:SUFFERN
Mailing Address - State:NY
Mailing Address - Zip Code:10901-5204
Mailing Address - Country:US
Mailing Address - Phone:845-368-2442
Mailing Address - Fax:845-368-3775
Practice Address - Street 1:222 ROUTE 59
Practice Address - Street 2:SUITE 305
Practice Address - City:SUFFERN
Practice Address - State:NY
Practice Address - Zip Code:10901-5204
Practice Address - Country:US
Practice Address - Phone:845-368-2442
Practice Address - Fax:845-368-3775
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN002996213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00440533Medicaid
NYT50953Medicare UPIN
NY00440533Medicaid