Provider Demographics
NPI:1669449112
Name:SCHUETTENBERG, SUSAN PINTO (OD)
Entity Type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:PINTO
Last Name:SCHUETTENBERG
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:725 PELHAMDALE AVE
Mailing Address - Street 2:
Mailing Address - City:PELHAM
Mailing Address - State:NY
Mailing Address - Zip Code:10803-1013
Mailing Address - Country:US
Mailing Address - Phone:914-738-9256
Mailing Address - Fax:914-738-4764
Practice Address - Street 1:33 W 42ND ST
Practice Address - Street 2:SUNY COLLEGE OF OPTOMETRY
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10036-8003
Practice Address - Country:US
Practice Address - Phone:212-938-4000
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-03
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYTUV005027-1152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00244528Medicaid
NYC4236Medicare ID - Type UnspecifiedMEDICARE ID
NY00244528Medicaid