Provider Demographics
NPI:1003267113
Name:GUTMAN, SUSANA (RDMS,RDCS, RVT)
Entity Type:Individual
Prefix:
First Name:SUSANA
Middle Name:
Last Name:GUTMAN
Suffix:
Gender:F
Credentials:RDMS,RDCS, RVT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10811A 66TH AVE
Mailing Address - Street 2:
Mailing Address - City:FOREST HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11375-2247
Mailing Address - Country:US
Mailing Address - Phone:718-838-4533
Mailing Address - Fax:888-645-9398
Practice Address - Street 1:10811A 66TH AVE
Practice Address - Street 2:
Practice Address - City:FOREST HILLS
Practice Address - State:NY
Practice Address - Zip Code:11375-2247
Practice Address - Country:US
Practice Address - Phone:718-838-4533
Practice Address - Fax:888-645-9398
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-29
Last Update Date:2016-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246XS1301XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist CardiovascularSonography
No2471V0105XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistVascular Sonography