Provider Demographics
NPI:1295757177
Name:MALLENBAUM, SUANNE GARBER (MD, PHD)
Entity type:Individual
Prefix:DR
First Name:SUANNE
Middle Name:GARBER
Last Name:MALLENBAUM
Suffix:
Gender:F
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 318H
Mailing Address - Street 2:
Mailing Address - City:SCARSDALE
Mailing Address - State:NY
Mailing Address - Zip Code:10583-8818
Mailing Address - Country:US
Mailing Address - Phone:914-382-6308
Mailing Address - Fax:914-381-6308
Practice Address - Street 1:1 WEST AVE
Practice Address - Street 2:SUITE 215
Practice Address - City:LARCHMONT
Practice Address - State:NY
Practice Address - Zip Code:10538-2470
Practice Address - Country:US
Practice Address - Phone:914-834-4379
Practice Address - Fax:914-381-2633
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1836992084P0005X, 2084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered2084P0005XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurodevelopmental Disabilities
Not Answered2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYG38184Medicare UPIN
NY48M01Medicare ID - Type Unspecified