Healthcare Provider Details

I. General information

NPI: 1356828404
Provider Name (Legal Business Name): SUSEL RODRIGUEZ ORTEGA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/22/2018
Last Update Date: 09/26/2023
Certification Date: 09/26/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26 INDIAN ROCK
SUFFERN NY
10901-4907
US

IV. Provider business mailing address

26 INDIAN ROCK
SUFFERN NY
10901-4907
US

V. Phone/Fax

Practice location:
  • Phone: 845-368-0100
  • Fax: 845-368-3866
Mailing address:
  • Phone: 845-368-0100
  • Fax: 845-368-3866

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License Number325892
License Number StateNY

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: