=====================================================
General NPI Number Information
=====================================================
NPI Number | 1811958457
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | SUSANNE APPEL M.D.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/31/2006
-----------------------------------------------------
Last Update Date | 05/14/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 12 W 96TH ST SUITE 1A
-----------------------------------------------------
City | NEW YORK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10025-6509
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 212-666-3766
-----------------------------------------------------
Fax | 212-662-8311
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 12 W 96TH ST APT. 12A
-----------------------------------------------------
City | NEW YORK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10025-6509
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 212-666-3766
-----------------------------------------------------
Fax | 212-662-8311
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2084P0804X
-----------------------------------------------------
Taxonomy Name | Child & Adolescent Psychiatry Physician
-----------------------------------------------------
License Number | 115868
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------