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General NPI Number Information
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NPI Number | 1104970516
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Entity Type | Individual
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Provider Name | SUSAN CHIRAYIL MD
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Gender | Female
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Dates
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Enumeration Date | 01/22/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 8045 WINCHESTER BLVD
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City | QUEENS VILLAGE
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State | NY
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Zip | 11427-2193
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Country | US
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Telephone | 718-264-3751
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Fax |
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Provider Business Mailing Address
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Address Line | 7 MARIETTA DR
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City | WESTBURY
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State | NY
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Zip | 11590-1115
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207QA0401X
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Taxonomy Name | Addiction Medicine (Family Medicine) Physician
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License Number | 139157
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License Number State | NY
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