| Doctor Name: | SUSAN MARIE NOLL |
| NPI Number: | 1467543298 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | NP |
| License Number: | F360052 |
| Business Practice Address: | 3001 Expressway Dr N 112 Islandia, NY - 117495301 |
| Business Phone Number: | 6314354322 |
| Business Fax Number: | 6314353423 |
| Mailing Address: | 3001 Expressway Dr N, 112 ISLANDIA |
| State: | NY |
| Postal Code: | 117495301 |
| Phone Number: | 6314354322 |
| Fax Number: | 6314353423 |
| NPI Enumeration Date: | 09/27/2006 |
| NPI Last Update Date: | 04/11/2016 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LX0001X |
| License Number: | F360052 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | NY |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Obstetrics & Gynecology |
| Taxonomy Definition: | |