Healthcare Provider Details

I. General information

NPI: 1386724862
Provider Name (Legal Business Name): SUSAN G BELLINSON CNM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/17/2006
Last Update Date: 10/25/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

MMG-CFCC 1621 EASTCHESTER ROAD
BRONX NY
10461
US

IV. Provider business mailing address

191 BEACH ST
BRONX NY
10464-1206
US

V. Phone/Fax

Practice location:
  • Phone: 718-405-8040
  • Fax:
Mailing address:
  • Phone: 718-405-8040
  • Fax: 718-405-8044

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License NumberF000028
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: