Active NPI
Susan Bolton, RN
- Registered Nurse
- Riverhead, NY
National Provider Identifier
1366953275
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Registered Nurse
- License
- 334467
- Practice address
- 300 Center Drive
East End Otp 2ND Floor
Riverhead, NY 11901 - Phone
- (631) 852-2680
- NPI assigned
- Oct 18, 2017
- 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 |
|---|---|---|---|---|
| Registered Nurse | 163W00000X | 334467 | NY | Primary |
Addresses
Primary practice location
300 Center Drive
East End Otp 2ND Floor
Riverhead, NY 11901
Mailing address
300 Center Drive
East End Otp 2ND Floor
Riverhead, NY 11901
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
- Registered Nurse
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 334467 | NY | MD | Licensed Practical Nurse |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1508284800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1508284800000",
"number": "1366953275",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "300 CENTER DRIVE",
"address_2": "EAST END OTP 2ND FLOOR",
"city": "RIVERHEAD",
"state": "NY",
"postal_code": "11901"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "300 CENTER DRIVE",
"address_2": "EAST END OTP 2ND FLOOR",
"city": "RIVERHEAD",
"state": "NY",
"postal_code": "11901",
"telephone_number": "631-852-2680"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BOLTON",
"first_name": "SUSAN",
"credential": "RN",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2017-10-18",
"last_updated": "2017-10-18",
"status": "A"
},
"taxonomies": [
{
"code": "163W00000X",
"taxonomy_group": "",
"desc": "Registered Nurse",
"state": "NY",
"license": "334467",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Riverhead, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 18, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.