Healthcare Provider Details

I. General information

NPI: 1194827162
Provider Name (Legal Business Name): SUSAN PATRICIA FLANAGAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/01/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

99 DUTCH HILL RD
ORANGEBURG NY
10962-2106
US

IV. Provider business mailing address

99 DUTCH HILL RD
ORANGEBURG NY
10962-2106
US

V. Phone/Fax

Practice location:
  • Phone: 845-398-2800
  • Fax: 845-398-2818
Mailing address:
  • Phone: 845-398-2800
  • Fax: 845-398-2818

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number001242-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: