Provider Demographics
NPI:1861653578
Name:MARSHALL, SUSAN (MD)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:
Last Name:MARSHALL
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:55 WATER ST
Mailing Address - Street 2:12TH FL., CREDENTIALING
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10041-0004
Mailing Address - Country:US
Mailing Address - Phone:646-680-2888
Mailing Address - Fax:516-542-5556
Practice Address - Street 1:215 E 95TH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10128-4077
Practice Address - Country:US
Practice Address - Phone:212-996-8000
Practice Address - Fax:212-423-3127
Is Sole Proprietor?:No
Enumeration Date:2008-06-24
Last Update Date:2017-02-06
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Provider Licenses
StateLicense IDTaxonomies
NY269406208800000X, 208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYA400160752Medicare PIN