Provider Demographics
NPI:1083644074
Name:FOX, SUSAN CAROL (MD)
Entity Type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:CAROL
Last Name:FOX
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:903 PARK AVE
Mailing Address - Street 2:FIRST FLOOR
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10021-0338
Mailing Address - Country:US
Mailing Address - Phone:212-288-2171
Mailing Address - Fax:212-153-5479
Practice Address - Street 1:903 PARK AVE
Practice Address - Street 2:FIRST FLOOR
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10021-0338
Practice Address - Country:US
Practice Address - Phone:212-288-2171
Practice Address - Fax:212-153-5479
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY150227207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
A64369Medicare UPIN