Active NPI
Rose Suzette Bristol
- Surgical Physician Assistant
- Brooklyn, NY
National Provider Identifier
1295009926
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Surgical Physician Assistant
- License
- 003327-1
- Practice address
- 339 Hicks St
3Rd Floor Fuller
Brooklyn, NY 11201-5509 - Phone
- (718) 780-1000
- Fax
- (718) 780-4911
- NPI assigned
- Feb 27, 2012
- Last updated
- Feb 27, 2012
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Surgical Physician Assistant | 363AS0400X | 003327-1 | NY | Primary |
Addresses
Primary practice location
339 Hicks St
3Rd Floor Fuller
Brooklyn, NY 11201-5509
Mailing address
339 Hicks St
3Rd Floor Fuller
Brooklyn, NY 11201-5509
Phone (718) 780-1000
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 003327-1 | NY | MD | Surgical Physician Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1330300800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1330300800000",
"number": "1295009926",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "339 HICKS ST",
"address_2": "3RD FLOOR FULLER",
"city": "BROOKLYN",
"state": "NY",
"postal_code": "112015509",
"telephone_number": "718-780-1000",
"fax_number": "718-780-4911"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "339 HICKS ST",
"address_2": "3RD FLOOR FULLER",
"city": "BROOKLYN",
"state": "NY",
"postal_code": "112015509",
"telephone_number": "718-780-1000",
"fax_number": "718-780-4911"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BRISTOL",
"first_name": "ROSE",
"middle_name": "SUZETTE",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2012-02-27",
"last_updated": "2012-02-27",
"status": "A"
},
"taxonomies": [
{
"code": "363AS0400X",
"taxonomy_group": "",
"desc": "Physician Assistant, Surgical",
"state": "NY",
"license": "003327-1",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Brooklyn, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 27, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.