Provider Demographics
NPI:1124187885
Name:CORWITH, SUSAN D (DC)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:D
Last Name:CORWITH
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:33 FLYING POINT RD STE 107
Mailing Address - Street 2:
Mailing Address - City:SOUTHAMPTON
Mailing Address - State:NY
Mailing Address - Zip Code:11968-5275
Mailing Address - Country:US
Mailing Address - Phone:631-287-2896
Mailing Address - Fax:631-287-0965
Practice Address - Street 1:33 FLYING POINT RD STE 107
Practice Address - Street 2:
Practice Address - City:SOUTHAMPTON
Practice Address - State:NY
Practice Address - Zip Code:11968-5275
Practice Address - Country:US
Practice Address - Phone:631-287-2896
Practice Address - Fax:631-287-0965
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-08
Last Update Date:2008-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX0026721111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYX15471Medicare PIN