Healthcare Provider Details

I. General information

NPI: 1578533428
Provider Name (Legal Business Name): SUSAN ZWANGER-MENDELSOHN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/24/2006
Last Update Date: 07/05/2023
Certification Date: 07/05/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

75 OVERLEA ST E
MASSAPEQUA PARK NY
11762-4018
US

IV. Provider business mailing address

75 OVERLEA ST E
MASSAPEQUA PARK NY
11762-4018
US

V. Phone/Fax

Practice location:
  • Phone: 516-697-3470
  • Fax: 646-355-1966
Mailing address:
  • Phone: 516-697-3470
  • Fax: 646-355-1966

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number153271
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: