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General NPI Number Information
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NPI Number | 1477791747
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Entity Type | Organization
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Legal Business Name | SUSAN MARSHALL, MD PC
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Dates
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Enumeration Date | 01/26/2009
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Last Update Date | 01/26/2009
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Provider Practice Location Address
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Address Line | 415 CENTRAL PARK WEST 1AF
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City | NEW YORK
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State | NY
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Zip | 10025
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Country | US
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Telephone | 212-222-1722
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Fax | 212-795-6320
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Provider Business Mailing Address
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Address Line | 15818 RIVERSIDE DRIVE WEST 5M
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City | NEW YORK
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State | NY
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Zip | 10032-1031
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Country | US
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Telephone | 212-222-1722
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Fax | 212-795-6320
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Authorized Official
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Title or Position | OWNER
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Name | SUSAN MARSHALL
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Credential | MD
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Telephone | 212-222-1722
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RN0300X
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Taxonomy Name | Nephrology Physician
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License Number | 25MA06631200
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License Number State | NJ
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Taxonomy #2
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Taxonomy Code | 207RN0300X
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Taxonomy Name | Nephrology Physician
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License Number | 184015
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License Number State | NY
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