Basic Information
| Provider Information | |||||||||
| NPI: | 1437314507 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ABATE | ||||||||
| FirstName: | SUSANNE | ||||||||
| MiddleName: | GABRIELLE | ||||||||
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| Credential: | AUD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3855 WEST CHESTER PIKE | ||||||||
| Address2: | SUITE 280 | ||||||||
| City: | NEWTOWN SQUARE | ||||||||
| State: | PA | ||||||||
| PostalCode: | 190732304 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6105574800 | ||||||||
| FaxNumber: | 3026514945 | ||||||||
| Practice Location | |||||||||
| Address1: | 3855 WEST CHESTER PIKE | ||||||||
| Address2: | SUITE 280 | ||||||||
| City: | NEWTOWN SQUARE | ||||||||
| State: | PA | ||||||||
| PostalCode: | 190732304 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6105574800 | ||||||||
| FaxNumber: | 3026514945 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/28/2008 | ||||||||
| LastUpdateDate: | 10/17/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 231H00000X | 02-0000167 | DE | N | Speech, Language and Hearing Service Providers | Audiologist | 231H00000X | AT006090 | PA | Y | Speech, Language and Hearing Service Providers | Audiologist |
ID Information
| ID | Type | State | Issuer | Description | 102230737 | 05 | PA | MEDICAID |