Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | 184015 | NY |
N | 111NI0900X | Internist | 184015 | NY |
Y | 207RN0300X | Nephrologist | 184015 | NY |
NPI | 1073672515 |
---|---|
Provider Name | Susan Marshall |
First Address | New York, NY 10032-1022 |
Second Address | New York, NY 10025-4856 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 08/12/2006 |
Last Update Date | 03/12/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
01616628 | (05) | NY |
G20183 | (02) | NY |