Provider Demographics
NPI:1437272614
Name:MALLOUK, SUZANNE (MD)
Entity Type:Individual
Prefix:
First Name:SUZANNE
Middle Name:
Last Name:MALLOUK
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 1:241 CENTRAL PARK W
Mailing Address - Street 2:SUITE 1D
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10024-4530
Mailing Address - Country:US
Mailing Address - Phone:212-866-5303
Mailing Address - Fax:347-438-2937
Practice Address - Street 1:241 CENTRAL PARK W
Practice Address - Street 2:SUITE 1D
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10024-4530
Practice Address - Country:US
Practice Address - Phone:212-866-5303
Practice Address - Fax:347-438-2937
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-10
Last Update Date:2010-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2333992084P0800X
CT0432372084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry