Individual
SUSAN FACKELMAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
259 1ST ST, MINEOLA, NY 11501-3957
(516) 663-0333
Mailing address
216 1ST ST, MINEOLA, NY 11501-3901
(516) 741-0570
(516) 741-8276
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
407482
NY
367500000X
Certified Registered Nurse Anesthetist
Primary
6675
NY
Other
Enumeration date
09/25/2006
Last updated
07/14/2020
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