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General NPI Number Information
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NPI Number | 1982142550
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Entity Type | Individual
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Provider Name | SUSMITA HAZARIKA
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Gender | Female
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Dates
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Enumeration Date | 02/03/2017
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Last Update Date | 11/21/2024
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Provider Practice Location Address
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Address Line | 1420 WALNUT ST STE 1012
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City | PHILADELPHIA
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State | PA
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Zip | 19102-4010
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Country | US
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Telephone | 855-940-4867
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Fax |
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Provider Business Mailing Address
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Address Line | 504 E 63RD ST APT 33L
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City | NEW YORK
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State | NY
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Zip | 10065-7929
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Country | US
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Telephone |
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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 | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 224287
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License Number State | NC
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Taxonomy #2
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 317453
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License Number State | NY
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Taxonomy #3
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | MD479425
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License Number State | PA
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