Provider Demographics
NPI:1972511376
Name:SCANGA, SUSAN (MA, OT, CHT)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:
Last Name:SCANGA
Suffix:
Gender:F
Credentials:MA, OT, CHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:125 CEDAR ST
Mailing Address - Street 2:#3S
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10006-1017
Mailing Address - Country:US
Mailing Address - Phone:212-406-2568
Mailing Address - Fax:212-267-2721
Practice Address - Street 1:125 CEDAR ST
Practice Address - Street 2:#3S
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10006-1017
Practice Address - Country:US
Practice Address - Phone:212-406-2568
Practice Address - Fax:212-267-2721
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-03
Last Update Date:2012-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY001700-1225XH1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHand
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYNS420OtherORTHONET
NY0C07351OtherHEALTHNET OF NY, INC.
NYQ7854OtherEMPIRE BC & BS
NYQ78541Medicare ID - Type UnspecifiedOCCUPATIONAL THERAPIST