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General NPI Number Information
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NPI Number | 1740345867
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Entity Type | Individual
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Provider Name | SUSAN F MCMAHON
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Gender | Female
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Dates
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Enumeration Date | 12/27/2006
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Last Update Date | 10/04/2012
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Provider Practice Location Address
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Address Line | 460 W 34TH ST 11TH FLOOR
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City | NEW YORK
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State | NY
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Zip | 10001-2320
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Country | US
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Telephone | 212-273-6519
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Fax |
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Provider Business Mailing Address
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Address Line | 53 CENTRAL AVE
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City | CALDWELL
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State | NJ
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Zip | 07006-4803
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Country | US
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Telephone | 973-615-3108
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Fax |
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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 | 174400000X
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Taxonomy Name | Specialist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 133V00000X
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Taxonomy Name | Registered Dietitian
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License Number | 005689-1
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License Number State | NY
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