Provider Demographics
NPI:1821220641
Name:MAMOT, SUSAN MEROY (DMD)
Entity Type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:MEROY
Last Name:MAMOT
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:347 5TH AVE
Mailing Address - Street 2:SUITE 703B
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10016-5010
Mailing Address - Country:US
Mailing Address - Phone:212-685-4150
Mailing Address - Fax:212-213-6882
Practice Address - Street 1:347 5TH AVE
Practice Address - Street 2:SUITE 703B
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10016-5010
Practice Address - Country:US
Practice Address - Phone:212-685-4150
Practice Address - Fax:212-213-6882
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-12
Last Update Date:2009-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0444901223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice