Provider Demographics
NPI:1104838911
Name:DROSSMAN, SUSAN ROBIN (MD)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:ROBIN
Last Name:DROSSMAN
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 1:488 MADISON AVENUE
Mailing Address - Street 2:SUITE 1220
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10022-5715
Mailing Address - Country:US
Mailing Address - Phone:212-755-7656
Mailing Address - Fax:212-688-9474
Practice Address - Street 1:488 MADISON AVENUE
Practice Address - Street 2:SUITE 1220
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10022-5715
Practice Address - Country:US
Practice Address - Phone:212-755-7656
Practice Address - Fax:212-688-9474
Is Sole Proprietor?:No
Enumeration Date:2006-08-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY17862112085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
F83427Medicare UPIN
NY20J68Medicare ID - Type Unspecified