Provider Demographics
NPI:1245592096
Name:FARBER, SUSAN DALE
Entity Type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:DALE
Last Name:FARBER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:99 ANNADALE RD
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10312-1503
Mailing Address - Country:US
Mailing Address - Phone:917-757-1917
Mailing Address - Fax:
Practice Address - Street 1:99 ANNADALE RD
Practice Address - Street 2:STATEN ISLAND
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10312-1503
Practice Address - Country:US
Practice Address - Phone:917-757-1917
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-07
Last Update Date:2012-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist