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General NPI Number Information
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NPI Number | 1255426110
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Entity Type | Individual
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Provider Name | SUSAN GUNDUZ MD
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Gender | Female
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Dates
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Enumeration Date | 10/04/2006
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Last Update Date | 11/30/2015
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Provider Practice Location Address
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Address Line | 1014 FORT SALONGA RD
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City | NORTHPORT
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State | NY
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Zip | 11768
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Country | US
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Telephone | 631-757-5604
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Fax | 631-757-2496
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Provider Business Mailing Address
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Address Line | 351 LARKFIELD RD
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City | EAST NORTHPORT
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State | NY
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Zip | 11731-2940
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Country | US
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Telephone | 631-757-5604
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Fax | 631-266-2190
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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 | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 164129
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License Number State | NY
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