Marie Graziella Surpris, D.O.

Primary specialty

Child & Adolescent Psychiatry PhysicianTaxonomy code 2084P0804X

License

2157481 Issued in NY

Practice address

148 Nichols Rd
Nesconset, NY 11767-2115

Phone

(631) 467-0867

Fax

(631) 467-0892

NPI assigned

May 21, 2007

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Opted out of Medicare

Yes, effective Dec 6, 2021 through Dec 6, 2027

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Osteopathy

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1179705600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1295944981",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "148 NICHOLS RD",
            "city": "NESCONSET",
            "state": "NY",
            "postal_code": "117672115",
            "telephone_number": "631-467-0867",
            "fax_number": "631-467-0892"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "148 NICHOLS RD",
            "city": "NESCONSET",
            "state": "NY",
            "postal_code": "117672115",
            "telephone_number": "631-467-0867",
            "fax_number": "631-467-0892"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SURPRIS",
        "first_name": "MARIE",
        "middle_name": "GRAZIELLA",
        "name_prefix": "Dr.",
        "credential": "D.O.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-05-21",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084P0804X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Child & Adolescent Psychiatry",
            "state": "NY",
            "license": "2157481",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Stacy Shapiro, SLP-CCC, P.C.
• Linda Stopsky, RN, IBCLC
• Lynne A Strollo, COTA
• Barbara Lynn Stumacher, M.D.
• Kathleen Edith Sullivan, CCC-SP
• Suchada Rachapat Surunna
• Linda Symington, AU.D.
• T.L.C.Physical Therapy,P.C.
• Ester Takhalova
• Justin Tate, MS, OTR/L

• Child & Adolescent Psychiatry Physician in Nesconset, NY
• Providers in Nesconset, NY by specialty
• Child & Adolescent Psychiatry Physician in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.