Provider Demographics
NPI:1053037267
Name:KNIGHT, SUSAN (LAC, DAC, MBA)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:
Last Name:KNIGHT
Suffix:
Gender:F
Credentials:LAC, DAC, MBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 VISTA AVE
Mailing Address - Street 2:
Mailing Address - City:OLD GREENWICH
Mailing Address - State:CT
Mailing Address - Zip Code:06870-2111
Mailing Address - Country:US
Mailing Address - Phone:914-826-3225
Mailing Address - Fax:
Practice Address - Street 1:100 MELROSE AVE STE 107
Practice Address - Street 2:
Practice Address - City:GREENWICH
Practice Address - State:CT
Practice Address - Zip Code:06830-6277
Practice Address - Country:US
Practice Address - Phone:203-274-1126
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-19
Last Update Date:2022-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT763171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist