Provider Demographics
NPI:1518217082
Name:MCQUILLAN, SUSAN (MS, RD)
Entity Type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:
Last Name:MCQUILLAN
Suffix:
Gender:F
Credentials:MS, RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:130 E 18TH ST
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10003-2416
Mailing Address - Country:US
Mailing Address - Phone:347-784-5070
Mailing Address - Fax:
Practice Address - Street 1:130 E 18TH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10003-2416
Practice Address - Country:US
Practice Address - Phone:347-784-5070
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-12
Last Update Date:2012-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered