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General NPI Number Information
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NPI Number | 1265702054
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Entity Type | Organization
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Legal Business Name | SUSAN G. MARGOLIS MD PC
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Dates
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Enumeration Date | 01/10/2012
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Last Update Date | 01/10/2012
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Provider Practice Location Address
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Address Line | 340 E 49TH ST
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City | NEW YORK
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State | NY
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Zip | 10017-1697
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Country | US
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Telephone | 212-751-5414
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Fax | 212-751-5434
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Provider Business Mailing Address
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Address Line | 340 E 49TH ST
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City | NEW YORK
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State | NY
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Zip | 10017-1697
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Country | US
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Telephone | 212-751-5414
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Fax | 212-751-5434
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Authorized Official
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Title or Position | PRESIDENT
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Name | SUSAN GAIL MARGOLIS
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Credential | MD
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Telephone | 212-751-5414
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM2500X
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Taxonomy Name | Medical Specialty Clinic/Center
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License Number | 185693
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License Number State | NY
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