Provider Demographics
NPI:1306189378
Name:FISCHER, SUSAN R (TEACHER)
Entity Type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:R
Last Name:FISCHER
Suffix:
Gender:F
Credentials:TEACHER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:513 8TH AVE
Mailing Address - Street 2:APT 3
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11215-3745
Mailing Address - Country:US
Mailing Address - Phone:718-788-5412
Mailing Address - Fax:
Practice Address - Street 1:513 8TH AVE
Practice Address - Street 2:APT 3
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11215-3745
Practice Address - Country:US
Practice Address - Phone:718-788-5412
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-28
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY$$$$$$$$$OtherTEACHER