Provider Demographics
NPI:1417073289
Name:SUSAN G. LOVE DPM
Entity Type:Organization
Organization Name:SUSAN G. LOVE DPM
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DPM
Authorized Official - Prefix:
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:G
Authorized Official - Last Name:LOVE
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:718-835-1453
Mailing Address - Street 1:15905 92ND ST
Mailing Address - Street 2:
Mailing Address - City:HOWARD BEACH
Mailing Address - State:NY
Mailing Address - Zip Code:11414-3123
Mailing Address - Country:US
Mailing Address - Phone:718-835-1453
Mailing Address - Fax:
Practice Address - Street 1:159-05 92ND STREET
Practice Address - Street 2:
Practice Address - City:HOWARD BEACH
Practice Address - State:NY
Practice Address - Zip Code:11414
Practice Address - Country:US
Practice Address - Phone:718-835-1453
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-22
Last Update Date:2008-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJN003949-1213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY480005518OtherMEDICARE RAILROAD
NY00966385Medicaid
NY00966385Medicaid
NY98378Medicare PIN