Active NPI
Jenny Rebecca Susser, PH.D.
- Exercise & Sports Psychologist
- Huntington, NY
National Provider Identifier
1346369923
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Exercise & Sports Psychologist
- License
- 015590
- Practice address
- 775 Park Ave
Suite 155
Huntington, NY 11743-3976 - Phone
- (631) 424-2587
- Fax
- (631) 424-8088
- NPI assigned
- Mar 28, 2007
- 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 |
|---|---|---|---|---|
| Exercise & Sports Psychologist | 103TE1100X | 015590 | NY | Primary |
Addresses
Primary practice location
775 Park Ave
Suite 155
Huntington, NY 11743-3976
Mailing address
2 Sheridan St
Huntington, NY 11743-6256
Phone (631) 424-2587
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
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 015590 | NY | MD | Massage Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1175040000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1346369923",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2 SHERIDAN ST",
"city": "HUNTINGTON",
"state": "NY",
"postal_code": "117436256",
"telephone_number": "631-424-2587",
"fax_number": "631-424-8088"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "775 PARK AVE",
"address_2": "SUITE 155",
"city": "HUNTINGTON",
"state": "NY",
"postal_code": "117433976",
"telephone_number": "631-424-2587",
"fax_number": "631-424-8088"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SUSSER",
"first_name": "JENNY",
"middle_name": "REBECCA",
"name_prefix": "Dr.",
"credential": "PH.D.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2007-03-28",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "103TE1100X",
"taxonomy_group": "",
"desc": "Psychologist, Exercise & Sports",
"state": "NY",
"license": "015590",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Huntington, NY
- Susan Sullivan, NP
- Sun River Health Inc
- George Surguladze
- Surya Wellness Massage Therapy PLLC
- Susan Lupia, Massage Therapy, PLLC
- Lisa Sutton, LCAT
- Moshe Suyunov
- Daniel Michael Sweeney Jr., DPT
- Sweetness Caring Hearts & Hands Inc. (Sweetness Skilled & Loving Home Care)
- Sweetness Skilled & Loving Care Inc.
Sources for this page
- 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.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.