Provider Demographics
NPI:1134378896
Name:DAUM, SUSAN M (MD)
Entity type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:M
Last Name:DAUM
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16 E 96TH ST
Mailing Address - Street 2:5A
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10128-0753
Mailing Address - Country:US
Mailing Address - Phone:212-876-9273
Mailing Address - Fax:
Practice Address - Street 1:16 E 96TH ST
Practice Address - Street 2:5A
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10128-0753
Practice Address - Country:US
Practice Address - Phone:212-876-9273
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-17
Last Update Date:2009-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY102844102L00000X, 2083P0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083P0500XAllopathic & Osteopathic PhysiciansPreventive MedicinePreventive Medicine/Occupational Environmental Medicine
No102L00000XBehavioral Health & Social Service ProvidersPsychoanalyst