Susan Nissle, L.AC

NPI 1922351204 · on the registry since 2012 · sole proprietor

Practice

Address: 23 Green St
Ste 107
Huntington, NY 11743
Phone: (646) 504-7228
Organisation at this address: Ernest P Larios Dds Pc
Regenerative Wellness Inc.
Five Harbors Psychology, Pllc
Inferred from a shared address, not stated in the registry.
Clinicians at this address: 11

Registry record

Primary taxonomy: 171100000X
171100000X
Licence states on file: NY
From the registry's licence fields, which are often incomplete.
Sex: Female
Record last updated: 2014-06-04

Source: CMS National Plan and Provider Enumeration System. Registration is not the same as practising, and the registry records no retirement — some people listed here no longer practise. More in New York