Healthcare Provider Details

I. General information

NPI: 1790751980
Provider Name (Legal Business Name): SUSAN PAGEL NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/27/2006
Last Update Date: 08/25/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1111 AMSTERDAM AVE CLARK 9
NEW YORK NY
10025-1716
US

IV. Provider business mailing address

5900 ARLINGTON AVE #3V
RIVERDALE NY
10471-1302
US

V. Phone/Fax

Practice location:
  • Phone: 212-523-4936
  • Fax: 212-636-1342
Mailing address:
  • Phone: 718-796-5915
  • Fax: 212-636-1342

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberF400103
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: