1104056464 NPI number — SUSAN GROPPE

Table of content: SUSAN GROPPE (NPI 1104056464)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1104056464 NPI number — SUSAN GROPPE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GROPPE
Provider First Name:
SUSAN
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1104056464
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/21/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
32 ROUNDTOP RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
YONKERS
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
10710-2328
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
914-282-2256
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3718-3726 HENRY HUDSON PKWY
Provider Second Line Business Practice Location Address:
SUITE 1005
Provider Business Practice Location Address City Name:
BRONX
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10463-1500
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-432-1618
Provider Business Practice Location Address Fax Number:
631-467-0928
Provider Enumeration Date:
07/21/2009

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: 225X00000X , with the licence number:  000870-1 , 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)





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