Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207U00000X | Nuclear Medicine Specialist | 304676 | NY |
NPI | 1548616147 |
---|---|
Provider Name | Susie Forbes |
First Address | Oradell, NJ 07649-2517 |
Second Address | Staten Island, NY 10305-3436 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/05/2016 |
Last Update Date | 20/05/2021 |