Provider Demographics
NPI:1235294323
Name:DECOTIIS, SUE GENE (MD)
Entity Type:Individual
Prefix:DR
First Name:SUE
Middle Name:GENE
Last Name:DECOTIIS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:104 E 40TH ST
Mailing Address - Street 2:#606
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10016-1801
Mailing Address - Country:US
Mailing Address - Phone:212-685-3640
Mailing Address - Fax:212-779-4780
Practice Address - Street 1:104 E 40TH ST
Practice Address - Street 2:#606
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10016-1801
Practice Address - Country:US
Practice Address - Phone:212-685-3640
Practice Address - Fax:212-779-4780
Is Sole Proprietor?:No
Enumeration Date:2006-12-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY150223207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYB14319Medicare UPIN