Provider Demographics
NPI:1144368465
Name:BUSSETTI, SUZANNE (CPNP)
Entity type:Individual
Prefix:MRS
First Name:SUZANNE
Middle Name:
Last Name:BUSSETTI
Suffix:
Gender:F
Credentials:CPNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 PROSPECT AVE
Mailing Address - Street 2:
Mailing Address - City:HACKENSACK
Mailing Address - State:NJ
Mailing Address - Zip Code:07601-1915
Mailing Address - Country:US
Mailing Address - Phone:551-996-5643
Mailing Address - Fax:551-996-5631
Practice Address - Street 1:620 COLUMBUS AVE
Practice Address - Street 2:STE 1
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10024-1458
Practice Address - Country:US
Practice Address - Phone:212-874-4500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-01
Last Update Date:2016-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2080A0000X2080A0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYF381444OtherLICENSE
NJ26NJ0000560OtherLICENSE