Provider Demographics
NPI:1255695177
Name:ROGERS, SUSAN E
Entity type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:E
Last Name:ROGERS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:504 SOUTHWOODS DR
Mailing Address - Street 2:
Mailing Address - City:MONTICELLO
Mailing Address - State:NY
Mailing Address - Zip Code:12701-7231
Mailing Address - Country:US
Mailing Address - Phone:845-794-6037
Mailing Address - Fax:845-794-4429
Practice Address - Street 1:504 SOUTHWOODS DR
Practice Address - Street 2:
Practice Address - City:MONTICELLO
Practice Address - State:NY
Practice Address - Zip Code:12701-7231
Practice Address - Country:US
Practice Address - Phone:845-794-6037
Practice Address - Fax:845-794-4429
Is Sole Proprietor?:No
Enumeration Date:2012-06-25
Last Update Date:2012-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program