Healthcare Provider Details

I. General information

NPI: 1891747499
Provider Name (Legal Business Name): SUSAN EMERSON M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SUSAN STRASSER M.D.

II. Dates (important events)

Enumeration Date: 05/16/2006
Last Update Date: 06/18/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

121 LEGION DR
COBLESKILL NY
12043-5111
US

IV. Provider business mailing address

PO BOX 725
COOPERSTOWN NY
13326-0725
US

V. Phone/Fax

Practice location:
  • Phone: 518-234-2555
  • Fax: 518-234-3415
Mailing address:
  • Phone: 518-234-2555
  • Fax: 518-234-3415

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number210046
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: