MEDICARE: SUSAN WORTSMAN MA-CCC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	231H00000X	Audiologist	000396-1	NY

General Provider Information

NPI Number	:	1841293990
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SUSAN WORTSMAN MA-CCC

Provider Business Mailing Address
First Line	:	68 ROCKLEDGE RD
Second Line	:	APT 1C
City	:	HARTSDALE
State	:	NY
Zip	:	10530-3455
Country	:	US
Telephone Number	:	212-481-4464
Fax Number	:

Provider Business Practice Location Address
First Line	:	425 E 25TH ST
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10010-2547
Country	:	US
Telephone Number	:	212-481-4464
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/23/2005
Last Update Date	:	07/08/2007

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