Healthcare Provider Details

I. General information

NPI: 1306052212
Provider Name (Legal Business Name): SUSAN BROWN PT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/15/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3486 SULIN CT
YORKTOWN HTS NY
10598-2219
US

IV. Provider business mailing address

3486 SULIN CT
YORKTOWN HEIGHTS NY
10598-2219
US

V. Phone/Fax

Practice location:
  • Phone: 914-844-0762
  • Fax: 914-245-7191
Mailing address:
  • Phone: 914-844-0762
  • Fax: 914-245-7191

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171W00000X
TaxonomyContractor
License Number008057-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: