Provider Demographics
NPI:1073559308
Name:STOPEK, SUSAN ELLEN (MD)
Entity Type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:ELLEN
Last Name:STOPEK
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 1:210 N BELLE MEAD RD
Mailing Address - Street 2:
Mailing Address - City:EAST SETAUKET
Mailing Address - State:NY
Mailing Address - Zip Code:11733-3458
Mailing Address - Country:US
Mailing Address - Phone:631-689-1400
Mailing Address - Fax:631-689-1595
Practice Address - Street 1:210 N BELLE MEAD RD
Practice Address - Street 2:
Practice Address - City:EAST SETAUKET
Practice Address - State:NY
Practice Address - Zip Code:11733-3458
Practice Address - Country:US
Practice Address - Phone:631-689-1400
Practice Address - Fax:631-689-1595
Is Sole Proprietor?:No
Enumeration Date:2006-06-22
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1359582084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY064846OtherVYTRA
NYP560482OtherOXFORD
NY00804435Medicaid
NY74A711OtherEMPIRE BLUE
NY0067035OtherGHI
NY74A711Medicare PIN
NYB19194Medicare UPIN