Provider Demographics
NPI:1518970888
Name:WELGRIN, SUSAN PAULINE (MD)
Entity Type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:PAULINE
Last Name:WELGRIN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22 PEPPERMILL RD
Mailing Address - Street 2:
Mailing Address - City:ROSLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11576-3106
Mailing Address - Country:US
Mailing Address - Phone:516-314-3688
Mailing Address - Fax:516-294-6451
Practice Address - Street 1:465 WILLIS AVE
Practice Address - Street 2:
Practice Address - City:WILLISTON PARK
Practice Address - State:NY
Practice Address - Zip Code:11596-1724
Practice Address - Country:US
Practice Address - Phone:516-294-3535
Practice Address - Fax:516-294-6451
Is Sole Proprietor?:No
Enumeration Date:2006-08-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY187440207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY75H602Medicare ID - Type Unspecified
NYF63137Medicare UPIN