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General NPI Number Information
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NPI Number | 1194918953
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Entity Type | Organization
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Legal Business Name | SUSAN GARDINER, PSYCHIATRIST,, P.C.
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Dates
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Enumeration Date | 08/23/2007
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Last Update Date | 08/23/2007
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Provider Practice Location Address
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Address Line | 785 DELAWARE AVE
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City | DELMAR
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State | NY
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Zip | 12054-9713
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Country | US
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Telephone | 518-439-1693
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Fax |
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Provider Business Mailing Address
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Address Line | 34 LONGWOOD DR
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City | DELMAR
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State | NY
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Zip | 12054-3737
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Country | US
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Telephone | 518-475-1909
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. SUSAN GARDINER
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Credential | M.D.
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Telephone | 518-475-1909
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 227621
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License Number State | NY
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