Provider Demographics
NPI:1679753032
Name:WIHNYK, SUSAN THERESA (RN)
Entity type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:THERESA
Last Name:WIHNYK
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:410 E BROADWAY
Mailing Address - Street 2:APT. 7P
Mailing Address - City:LONG BEACH
Mailing Address - State:NY
Mailing Address - Zip Code:11561-4446
Mailing Address - Country:US
Mailing Address - Phone:516-208-5788
Mailing Address - Fax:
Practice Address - Street 1:410 E BROADWAY
Practice Address - Street 2:APT. 7P
Practice Address - City:LONG BEACH
Practice Address - State:NY
Practice Address - Zip Code:11561-4446
Practice Address - Country:US
Practice Address - Phone:516-208-5788
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-13
Last Update Date:2007-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY244031-1163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02914890Medicaid