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General NPI Number Information
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NPI Number | 1588740880
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Entity Type | Individual
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Provider Name | SUSAN ROGGEN TANKE CNM, NP
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Gender | Female
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Dates
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Enumeration Date | 10/29/2006
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Last Update Date | 12/15/2017
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Provider Practice Location Address
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Address Line | 1400 PELHAM PARKWAY SOUTH BUILDING 1 3 WEST 7
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City | BRONX
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State | NY
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Zip | 10461
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Country | US
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Telephone | 718-918-5446
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Fax | 718-918-6787
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Provider Business Mailing Address
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Address Line | 1400 PELHAM PARKWAY SOUTH BUILDING 1 3 WEST 7
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City | BRONX
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State | NY
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Zip | 10461
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Country | US
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Telephone | 718-918-5446
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Fax | 718-918-6787
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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 | 176B00000X
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Taxonomy Name | Midwife
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License Number | F000783
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 363LW0102X
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Taxonomy Name | Women's Health Nurse Practitioner
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License Number | F420555
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License Number State | NY
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