Provider Demographics
NPI:1710256789
Name:ROTHCHILD, SUSAN (MS)
Entity Type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:
Last Name:ROTHCHILD
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6072 STATE FARM RD
Mailing Address - Street 2:
Mailing Address - City:GUILDERLAND
Mailing Address - State:NY
Mailing Address - Zip Code:12084-9532
Mailing Address - Country:US
Mailing Address - Phone:518-456-6010
Mailing Address - Fax:518-456-3747
Practice Address - Street 1:6072 STATE FARM RD
Practice Address - Street 2:
Practice Address - City:GUILDERLAND
Practice Address - State:NY
Practice Address - Zip Code:12084-9532
Practice Address - Country:US
Practice Address - Phone:518-456-6010
Practice Address - Fax:518-456-3747
Is Sole Proprietor?:No
Enumeration Date:2011-12-21
Last Update Date:2011-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY002968-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist