Provider Demographics
NPI:1184689192
Name:SCHAFFER, SUSAN MARY (PT)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:MARY
Last Name:SCHAFFER
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:145 E PROSPECT AVE
Mailing Address - Street 2:
Mailing Address - City:HAMBURG
Mailing Address - State:NY
Mailing Address - Zip Code:14075-5215
Mailing Address - Country:US
Mailing Address - Phone:716-649-4308
Mailing Address - Fax:
Practice Address - Street 1:145 E PROSPECT AVE
Practice Address - Street 2:
Practice Address - City:HAMBURG
Practice Address - State:NY
Practice Address - Zip Code:14075-5215
Practice Address - Country:US
Practice Address - Phone:716-649-4308
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02141317Medicaid
NYCC4770Medicare ID - Type Unspecified