Provider Demographics
NPI:1407817224
Name:RISTOW, SUSAN C (MD)
Entity Type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:C
Last Name:RISTOW
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:540 ANTLERS DR
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14618-2128
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:220 ALEXANDER ST
Practice Address - Street 2:SUITE 402
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14607-4008
Practice Address - Country:US
Practice Address - Phone:585-922-8350
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-31
Last Update Date:2007-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY122410207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology