Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RH0000X | Hematologist | 107022 | NY |
NPI | 1205911088 |
---|---|
Provider Name | Ira I Sussman |
First Address | West Nyack, NY 10994-1213 |
Second Address | Bronx, NY 10467 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/10/2006 |
Last Update Date | 08/07/2007 |