Provider Demographics
NPI:1972599207
Name:SUESSERMAN, DAVID (DC)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:
Last Name:SUESSERMAN
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:310 WOODS AVE
Mailing Address - Street 2:
Mailing Address - City:OCEANSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11572-2146
Mailing Address - Country:US
Mailing Address - Phone:516-992-8196
Mailing Address - Fax:516-992-8198
Practice Address - Street 1:95 CLINTON ST
Practice Address - Street 2:
Practice Address - City:HEMPSTEAD
Practice Address - State:NY
Practice Address - Zip Code:11550-4211
Practice Address - Country:US
Practice Address - Phone:516-992-8196
Practice Address - Fax:516-992-8198
Is Sole Proprietor?:No
Enumeration Date:2005-09-22
Last Update Date:2018-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX009397111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
U62600Medicare UPIN
NY02011VMedicare PIN
NYX8D881Medicare PIN