Healthcare Provider Details

I. General information

NPI: 1164390100
Provider Name (Legal Business Name): SUSAN FORSYTHE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/29/2025
Last Update Date: 08/31/2026
Certification Date: 08/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

107 W 82ND ST STE 108
NEW YORK NY
10024-5511
US

IV. Provider business mailing address

16129 JEWEL AVE APT 5J
FRESH MEADOWS NY
11365-4365
US

V. Phone/Fax

Practice location:
  • Phone: 917-558-0228
  • Fax:
Mailing address:
  • Phone: 917-488-8072
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number030067
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number016396-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: