1881848794 NPI number — DR. SUZANNE SILVERMAN FENSKE M.D.

Table of content: DR. SUZANNE SILVERMAN FENSKE M.D. (NPI 1881848794)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1881848794 NPI number — DR. SUZANNE SILVERMAN FENSKE M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
FENSKE
Provider First Name:
SUZANNE
Provider Middle Name:
SILVERMAN
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
SILVERMAN
Provider Other First Name:
SUZANNE
Provider Other Middle Name:
KESSLER
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
M.D.
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1881848794
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/06/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
645 MADISON AVENUE
Provider Second Line Business Mailing Address:
6TH FLOOR-TARA MD
Provider Business Mailing Address City Name:
NEW YORK
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
10022
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
212-988-0562
Provider Business Mailing Address Fax Number:
833-584-0695

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
645 MADISON AVENUE
Provider Second Line Business Practice Location Address:
6TH FLOOR-TARA MD
Provider Business Practice Location Address City Name:
NEW YORK
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10022
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
212-988-0562
Provider Business Practice Location Address Fax Number:
833-584-0695
Provider Enumeration Date:
11/06/2008

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207V00000X , with the licence number:  75743 , registered in the state of CT ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207V00000X , with the licence number: 261212 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)