Provider Demographics
NPI:1073657102
Name:SUZANNE GREENIDGE
Entity Type:Organization
Organization Name:SUZANNE GREENIDGE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:M.D.
Authorized Official - Prefix:DR
Authorized Official - First Name:LAURE
Authorized Official - Middle Name:MYRLAINE
Authorized Official - Last Name:LAURISTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:917-892-5823
Mailing Address - Street 1:47 DAVIS AVE APT 2F
Mailing Address - Street 2:
Mailing Address - City:WHITE PLAINS
Mailing Address - State:NY
Mailing Address - Zip Code:10605-1013
Mailing Address - Country:US
Mailing Address - Phone:917-892-5823
Mailing Address - Fax:
Practice Address - Street 1:1020 N BROADWAY
Practice Address - Street 2:
Practice Address - City:YONKERS
Practice Address - State:NY
Practice Address - Zip Code:10701-1303
Practice Address - Country:US
Practice Address - Phone:914-375-2800
Practice Address - Fax:914-375-7329
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY242494207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty