=====================================================
General NPI Number Information
=====================================================
NPI Number | 1699981779
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SUSAN L. UNGAR, M.D., P.C.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/15/2007
-----------------------------------------------------
Last Update Date | 07/29/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 135 W 70TH ST SUITE 1K
-----------------------------------------------------
City | NEW YORK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10023-4458
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 212-787-7546
-----------------------------------------------------
Fax | 212-787-7545
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 135 W 70TH ST SUITE 1K
-----------------------------------------------------
City | NEW YORK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10023-4458
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 212-787-7546
-----------------------------------------------------
Fax | 212-787-7545
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | SOLE OWNER
-----------------------------------------------------
Name | DR. SUSAN LISA UNGAR
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 212-787-7546
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207N00000X
-----------------------------------------------------
Taxonomy Name | Dermatology Physician
-----------------------------------------------------
License Number | 191425
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------