Healthcare Provider Details

I. General information

NPI: 1154385524
Provider Name (Legal Business Name): SCOTT SUCHIN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/13/2006
Last Update Date: 05/22/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1250 WATERS PL SUITE 1201
BRONX NY
10461-2720
US

IV. Provider business mailing address

1250 WATERS PL SUITE 1201
BRONX NY
10461-2720
US

V. Phone/Fax

Practice location:
  • Phone: 718-239-0115
  • Fax: 718-239-0446
Mailing address:
  • Phone: 718-239-0115
  • Fax: 718-239-0446

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number219655
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: