Healthcare Provider Details

I. General information

NPI: 1861653578
Provider Name (Legal Business Name): SUSAN MARSHALL M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/24/2008
Last Update Date: 02/06/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

215 E 95TH ST
NEW YORK NY
10128-4077
US

IV. Provider business mailing address

55 WATER ST 12TH FL., CREDENTIALING
NEW YORK NY
10041-0004
US

V. Phone/Fax

Practice location:
  • Phone: 212-996-8000
  • Fax: 212-423-3127
Mailing address:
  • Phone: 646-680-2888
  • Fax: 516-542-5556

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number269406
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: