Healthcare Provider Details

I. General information

NPI: 1669498911
Provider Name (Legal Business Name): SUSAN MARIE BEATTY MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/13/2006
Last Update Date: 12/05/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

75 CRYSTAL RUN RD HORTON PAVILION
MIDDLETOWN NY
10940
US

IV. Provider business mailing address

PO BOX 29
GOSHEN NY
10924-0029
US

V. Phone/Fax

Practice location:
  • Phone: 845-343-0616
  • Fax: 845-343-0617
Mailing address:
  • Phone: 845-615-1141
  • Fax: 845-294-4366

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number202537
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number25MA07222300
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: