Healthcare Provider Details

I. General information

NPI: 1992943013
Provider Name (Legal Business Name): SUZANNE SHAIR PT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/27/2009
Last Update Date: 06/15/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

473 FDR DR STOREFRONT
NEW YORK NY
10002-2024
US

IV. Provider business mailing address

477 FDR DR #M1901
NEW YORK NY
10002-2062
US

V. Phone/Fax

Practice location:
  • Phone: 212-475-2000
  • Fax: 212-475-2021
Mailing address:
  • Phone: 917-721-4522
  • Fax: 212-475-2021

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number015866-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: