MEDICARE: MRS. SUSAN CLAIRE LUDWIG

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	036432	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1265614572
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. SUSAN CLAIRE LUDWIG

Provider Business Mailing Address
First Line	:	45 HOBART ST
Second Line	:
City	:	EAST ISLIP
State	:	NY
Zip	:	11730-2829
Country	:	US
Telephone Number	:	631-224-4767
Fax Number	:

Provider Business Practice Location Address
First Line	:	836 SUNRISE HWY
Second Line	:
City	:	BAY SHORE
State	:	NY
Zip	:	11706-5908
Country	:	US
Telephone Number	:	631-665-2500
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/28/2007
Last Update Date	:	11/28/2007

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