MEDICARE: DR. SUSAN HYMAN PINCUS M.D.

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	207QG0300X	Geriatric Medicine (Family Medicine) Physician	139648	NY

General Provider Information

NPI Number	:	1285628818
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SUSAN HYMAN PINCUS M.D.

Provider Business Mailing Address
First Line	:	79 LAIGHT ST
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10013-2000
Country	:	US
Telephone Number	:	212-941-9040
Fax Number	:

Provider Business Practice Location Address
First Line	:	200 PARK AVE S
Second Line	:	3RD FLOOR
City	:	NEW YORK
State	:	NY
Zip	:	10003-1503
Country	:	US
Telephone Number	:	212-780-4459
Fax Number	:	212-420-7211

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

Provider Enumeration Date	:	09/09/2005
Last Update Date	:	07/08/2007

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