Provider Demographics
NPI:1043262686
Name:STENSON, SUSAN MARY (MD)
Entity Type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:MARY
Last Name:STENSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:614 2ND AVE
Mailing Address - Street 2:SUITE C
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10016-4889
Mailing Address - Country:US
Mailing Address - Phone:212-684-1633
Mailing Address - Fax:
Practice Address - Street 1:614 2ND AVE
Practice Address - Street 2:SUITE C
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10016-4889
Practice Address - Country:US
Practice Address - Phone:212-684-1633
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-16
Last Update Date:2011-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY109592207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYB20671Medicare UPIN
NY972431Medicare ID - Type Unspecified