Provider Demographics
NPI:1225069610
Name:SUSMAN, MARCY (MD)
Entity Type:Individual
Prefix:DR
First Name:MARCY
Middle Name:
Last Name:SUSMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:609 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:CEDARHURST
Mailing Address - State:NY
Mailing Address - Zip Code:11516-2601
Mailing Address - Country:US
Mailing Address - Phone:516-569-0093
Mailing Address - Fax:212-508-0047
Practice Address - Street 1:342 EAST 49 ST
Practice Address - Street 2:BEEKMAN RADIOLOGY PLLC
Practice Address - City:NY
Practice Address - State:NY
Practice Address - Zip Code:10017
Practice Address - Country:US
Practice Address - Phone:212-508-0045
Practice Address - Fax:212-508-0047
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1931102085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYG45653Medicare UPIN