Individual ProviderSusie GladdenLicensed Practical NurseNursing Service ProvidersPractice Address1 Park Ave Apt 5, Patchogue, NY 11772-2274(631) 310-2296PECOS EnrollmentBased on the most recent information from CMS, provider Susie Gladden does not have current enrollment records in PECOS.Part BMedicare Part BNot EnrolledHHAHome Health AgencyNot EnrolledDMEDurable Medical EquipmentNot EnrolledPMDPower Mobility DeviceNot EnrolledCMS last updated its PECOS records 2 days ago.Profile DetailsProvider ID1780280552Provider TypeIndividualFull NameGladden, SusieTitleMs.GenderFemaleSole ProprietorNoEnumeration Date12/8/2020Last Updated12/8/2020Contact InformationPractice LocationPractice Address1 Park Ave Apt 5, Patchogue, NY 11772-2274Phone(631) 310-2296FaxUnlisted FaxMailing LocationMailing Address1 Park Ave Apt 5, Patchogue, NY 11772-2274Phone(631) 310-2296FaxUnlisted FaxProvider TaxonomiesCodeDescriptionLicenseCode164W00000XPrimaryDescriptionLicensed Practical NurseNursing Service ProvidersLicense331961New YorkProvider IdentifiersIDDescriptionIssuerID331961DescriptionMedicaidIssuerUnlistedNew York