Provider Demographics
NPI:1619201910
Name:NITKA, SUSAN GABEL (MD)
Entity Type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:GABEL
Last Name:NITKA
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 1:6069 BAY HILL CIR
Mailing Address - Street 2:
Mailing Address - City:JAMESVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:13078-3714
Mailing Address - Country:US
Mailing Address - Phone:315-427-1184
Mailing Address - Fax:
Practice Address - Street 1:6069 BAY HILL CIR
Practice Address - Street 2:
Practice Address - City:JAMESVILLE
Practice Address - State:NY
Practice Address - Zip Code:13078-3714
Practice Address - Country:US
Practice Address - Phone:315-427-1184
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-21
Last Update Date:2009-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY170186-1207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology