Provider Demographics
NPI:1639133242
Name:MIRRA, SUZANNE S (MD)
Entity Type:Individual
Prefix:DR
First Name:SUZANNE
Middle Name:S
Last Name:MIRRA
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Gender:F
Credentials:MD
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Mailing Address - Street 1:111 HICKS ST
Mailing Address - Street 2:APARTMENT 22A
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11201-1658
Mailing Address - Country:US
Mailing Address - Phone:718-270-2746
Mailing Address - Fax:718-270-4416
Practice Address - Street 1:450 CLARKSON AVE
Practice Address - Street 2:BSB4-5
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11203-2056
Practice Address - Country:US
Practice Address - Phone:718-270-2746
Practice Address - Fax:718-270-4416
Is Sole Proprietor?:No
Enumeration Date:2006-04-12
Last Update Date:2007-07-08
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Provider Licenses
StateLicense IDTaxonomies
NY105788-1207ZN0500X, 207ZP0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered207ZN0500XAllopathic & Osteopathic PhysiciansPathologyNeuropathology
Not Answered207ZP0101XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology