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NPI Code Detail

MEDICARE: SUSAN MANSUKHLAL KANSAGRA MD, MBA

MEDICARE:   SUSAN MANSUKHLAL KANSAGRA  MD, MBA
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
1207R00000XInternal Medicine Physician249247-1NY

General Provider Information

NPI Number : 1841327277
Entity Type Code : Individual
Provider Name (Legal Business Name) : SUSAN MANSUKHLAL KANSAGRA MD, MBA
Provider Business Mailing Address
First Line : 125 WORTH ST
Second Line : ROOM 349
City : NEW YORK
State : NY
Zip : 10013-4006
Country : US
Telephone Number : 212-788-7493
Fax Number :
Provider Business Practice Location Address
First Line : 125 WORTH ST
Second Line : ROOM 349
City : NEW YORK
State : NY
Zip : 10013-4006
Country : US
Telephone Number : 212-788-7493
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/27/2007
Last Update Date : 11/11/2008

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