Healthcare Provider Details

I. General information

NPI: 1962489583
Provider Name (Legal Business Name): SUSAN EPSTEIN MS RD CDN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: SUSAN SHIEL

II. Dates (important events)

Enumeration Date: 12/23/2005
Last Update Date: 03/11/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

255 LAFAYETTE AVE
SUFFERN NY
10901-4812
US

IV. Provider business mailing address

20 GRAND ST FL 3
WARWICK NY
10990-1035
US

V. Phone/Fax

Practice location:
  • Phone: 845-368-5000
  • Fax:
Mailing address:
  • Phone: 845-987-3973
  • Fax: 845-987-5979

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number003004-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: