Provider Demographics
NPI:1003947433
Name:CABLE, SUSAN POLONSKY (PT)
Entity Type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:POLONSKY
Last Name:CABLE
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:43 GREENWOOD RD
Mailing Address - Street 2:
Mailing Address - City:SHARON
Mailing Address - State:MA
Mailing Address - Zip Code:02067-1232
Mailing Address - Country:US
Mailing Address - Phone:781-784-5258
Mailing Address - Fax:
Practice Address - Street 1:43 GREENWOOD RD
Practice Address - Street 2:
Practice Address - City:SHARON
Practice Address - State:MA
Practice Address - Zip Code:02067-1232
Practice Address - Country:US
Practice Address - Phone:781-784-5258
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1609174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAY66610OtherBCBS