Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207R00000X | Internist | 71115 | NY |
Y | 111NI0900X | Internist | 71115 | NY |
N | 207RX0202X | Medical Oncology | 071115 | NY |
NPI | 1134248636 |
---|---|
Provider Name | Dr. Susan Hacker-Jakus |
First Address | Bronx, NY 10467-2401 |
Second Address | Bronx, NY 10467-2401 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/03/2007 |
Last Update Date | 13/09/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
071115 | MEDICAL ONCOLOGY (01) | NY |
1403971 | LICENSE (01) | NY |
71115 | INTERNAL MEDICINE (01) | NY |
AJ1047732 | DEA NUMBER (01) | NY |
G52319 | (02) | NY |