Individual
MRS. SUSAN M AVERSO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PNP
Contact information
Practice address
35 LONGWOOD RD, MIDDLE ISLAND, NY 11953-2045
(631) 924-1000
(631) 924-1243
Mailing address
PO BOX 12, MIDDLE ISLAND, NY 11953-0012
(631) 924-1000
(631) 924-1243
Taxonomy
Speciality
Code
Description
License number
State
363LP0200X
Pediatric Nurse Practitioner
Primary
F381569-1
NY
Other
Enumeration date
09/13/2011
Last updated
09/13/2011
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