Provider Demographics
NPI:1558324673
Name:NOAH, SUSAN (PA)
Entity Type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:
Last Name:NOAH
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:266 WEST 145TH ST
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10039-4104
Mailing Address - Country:US
Mailing Address - Phone:212-690-4002
Mailing Address - Fax:212-690-3264
Practice Address - Street 1:266 W 145TH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10039-4104
Practice Address - Country:US
Practice Address - Phone:212-690-4002
Practice Address - Fax:212-690-3264
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-10
Last Update Date:2011-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY008561363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant