Provider Demographics
NPI:1538395900
Name:MISKIN, SUSAN (SP ED/ MS)
Entity type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:
Last Name:MISKIN
Suffix:
Gender:F
Credentials:SP ED/ MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1956 ARTHUR KILL RD
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10312-1168
Mailing Address - Country:US
Mailing Address - Phone:917-693-1821
Mailing Address - Fax:
Practice Address - Street 1:1956 ARTHUR KILL RD
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10312-1168
Practice Address - Country:US
Practice Address - Phone:917-693-1821
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-30
Last Update Date:2009-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY25508174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist