Provider Demographics
NPI:1063677656
Name:ALKASAB, SUSAN LAELA (MD)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:LAELA
Last Name:ALKASAB
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 1:300 COMMUNITY DR
Mailing Address - Street 2:DEPARTMENT OB/GYN 4 LEVITT
Mailing Address - City:MANHASSET
Mailing Address - State:NY
Mailing Address - Zip Code:11030-3816
Mailing Address - Country:US
Mailing Address - Phone:516-562-4435
Mailing Address - Fax:
Practice Address - Street 1:825 NORTHERN BLVD
Practice Address - Street 2:SUITE 301
Practice Address - City:GREAT NECK
Practice Address - State:NY
Practice Address - Zip Code:11021-5323
Practice Address - Country:US
Practice Address - Phone:516-472-5700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-23
Last Update Date:2008-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY249569207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology