Provider Demographics
NPI:1578533428
Name:ZWANGER-MENDELSOHN, SUSAN (MD)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:
Last Name:ZWANGER-MENDELSOHN
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 1:75 OVERLEA ST E
Mailing Address - Street 2:
Mailing Address - City:MASSAPEQUA PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11762-4018
Mailing Address - Country:US
Mailing Address - Phone:516-697-3470
Mailing Address - Fax:646-355-1966
Practice Address - Street 1:75 OVERLEA ST E
Practice Address - Street 2:
Practice Address - City:MASSAPEQUA PARK
Practice Address - State:NY
Practice Address - Zip Code:11762-4018
Practice Address - Country:US
Practice Address - Phone:516-697-3470
Practice Address - Fax:646-355-1966
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-24
Last Update Date:2023-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1532712085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01513588Medicaid
NY01513588Medicaid
NYE70109Medicare UPIN