Provider Demographics
NPI:1912202680
Name:SLACK, SUSAN T (RN)
Entity Type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:T
Last Name:SLACK
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:80 VANDAM ST
Mailing Address - Street 2:C/O NURSE OFFICE, 7 TH FLOOR
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10013-1009
Mailing Address - Country:US
Mailing Address - Phone:212-366-8387
Mailing Address - Fax:212-366-8319
Practice Address - Street 1:80 VANDAM ST
Practice Address - Street 2:C/O NURSE OFFICE, 7 TH FLOOR
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10013-1009
Practice Address - Country:US
Practice Address - Phone:212-366-8387
Practice Address - Fax:212-366-8319
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-11
Last Update Date:2011-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY294545163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse