Healthcare Provider Details

I. General information

NPI: 1649367913
Provider Name (Legal Business Name): SUSAN H SWEZEY M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/06/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

173 E SHORE RD
GREAT NECK NY
11023-2415
US

IV. Provider business mailing address

173 E SHORE RD
GREAT NECK NY
11023
US

V. Phone/Fax

Practice location:
  • Phone: 516-487-4020
  • Fax: 516-487-4039
Mailing address:
  • Phone: 516-487-4020
  • Fax: 516-487-4039

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number169597
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: