Healthcare Provider Details

I. General information

NPI: 1508853805
Provider Name (Legal Business Name): SUSAN RUTH CLARVIT MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/02/2005
Last Update Date: 07/14/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1120 PARK AVE
NEW YORK NY
10128-1242
US

IV. Provider business mailing address

1120 PARK AVE
NEW YORK NY
10128-1242
US

V. Phone/Fax

Practice location:
  • Phone: 212-996-9245
  • Fax: 914-693-0023
Mailing address:
  • Phone: 212-996-9245
  • Fax: 914-693-0023

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number164380
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number164380
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: