MEDICARE: MRS. SUSAN NOAH PA

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	363A00000X	Physician Assistant	008561	NY

General Provider Information

NPI Number	:	1558324673
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. SUSAN NOAH PA

Provider Business Mailing Address
First Line	:	266 WEST 145TH ST
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10039-4104
Country	:	US
Telephone Number	:	212-690-4002
Fax Number	:	212-690-3264

Provider Business Practice Location Address
First Line	:	266 W 145TH ST
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10039-4104
Country	:	US
Telephone Number	:	212-690-4002
Fax Number	:	212-690-3264

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

Provider Enumeration Date	:	04/10/2006
Last Update Date	:	07/08/2011

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