MEDICARE: DR. SUSAN D GIEROK PHD

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	103G00000X	Clinical Neuropsychologist	1334	AL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	051555700	OTHER	AL	MEDICARE PROVIDER NUMBER

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	051527334	OTHER	AL	BLUE CROSS PROVIDER NUMBE

General Provider Information

NPI Number	:	1669652657
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SUSAN D GIEROK PHD

Provider Business Mailing Address
First Line	:	1800 S AUSTRALIAN AVE
Second Line	:	SUITE 205
City	:	WEST PALM BEACH
State	:	FL
Zip	:	33409-6450
Country	:	US
Telephone Number	:	561-317-9955
Fax Number	:	561-689-0806

Provider Business Practice Location Address
First Line	:	1800 S AUSTRALIAN AVE
Second Line	:	SUITE 205
City	:	WEST PALM BEACH
State	:	FL
Zip	:	33409-6450
Country	:	US
Telephone Number	:	561-317-9955
Fax Number	:	561-689-0806

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

Provider Enumeration Date	:	11/07/2007
Last Update Date	:	07/25/2008

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