Provider Demographics
NPI:1225204324
Name:KANE, SUSAN INA (DO)
Entity Type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:INA
Last Name:KANE
Suffix:
Gender:F
Credentials:DO
Other - Prefix:DR
Other - First Name:SUSAN
Other - Middle Name:INA
Other - Last Name:HABER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:2280 GRAND AVE
Mailing Address - Street 2:SUITE 208
Mailing Address - City:BALDWIN
Mailing Address - State:NY
Mailing Address - Zip Code:11510-3164
Mailing Address - Country:US
Mailing Address - Phone:516-623-4800
Mailing Address - Fax:516-378-1871
Practice Address - Street 1:2280 GRAND AVE
Practice Address - Street 2:SUITE 208
Practice Address - City:BALDWIN
Practice Address - State:NY
Practice Address - Zip Code:11510-3164
Practice Address - Country:US
Practice Address - Phone:516-623-4800
Practice Address - Fax:516-378-1871
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-08
Last Update Date:2016-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY190439207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine