Provider Demographics
NPI:1467908285
Name:ASTOR, SUSAN DORIS (MS)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:DORIS
Last Name:ASTOR
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 LIBERTY ST
Mailing Address - Street 2:
Mailing Address - City:NEW PALTZ
Mailing Address - State:NY
Mailing Address - Zip Code:12561-4315
Mailing Address - Country:US
Mailing Address - Phone:516-443-6689
Mailing Address - Fax:
Practice Address - Street 1:5 LIBERTY ST
Practice Address - Street 2:
Practice Address - City:NEW PALTZ
Practice Address - State:NY
Practice Address - Zip Code:12561-4315
Practice Address - Country:US
Practice Address - Phone:845-633-8150
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-31
Last Update Date:2016-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist