Provider Demographics
NPI:1588900849
Name:JOKI, SUSAN T
Entity type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:T
Last Name:JOKI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:674 ROUTE 29
Mailing Address - Street 2:
Mailing Address - City:SARATOGA SPRINGS
Mailing Address - State:NY
Mailing Address - Zip Code:12866-5402
Mailing Address - Country:US
Mailing Address - Phone:518-584-5548
Mailing Address - Fax:
Practice Address - Street 1:674 ROUTE 29
Practice Address - Street 2:
Practice Address - City:SARATOGA SPRINGS
Practice Address - State:NY
Practice Address - Zip Code:12866-5402
Practice Address - Country:US
Practice Address - Phone:518-584-5548
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-13
Last Update Date:2012-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0004565-1174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist