Provider Demographics
NPI:1508949603
Name:FROMER, SUSAN DIANE (MD)
Entity Type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:DIANE
Last Name:FROMER
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:10933 71ST RD
Mailing Address - Street 2:SUITE 2C
Mailing Address - City:FOREST HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11375-4850
Mailing Address - Country:US
Mailing Address - Phone:718-261-3366
Mailing Address - Fax:718-261-6773
Practice Address - Street 1:550 PARK AVE
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10021-7369
Practice Address - Country:US
Practice Address - Phone:212-832-9228
Practice Address - Fax:212-751-9482
Is Sole Proprietor?:No
Enumeration Date:2006-10-23
Last Update Date:2024-02-19
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Provider Licenses
StateLicense IDTaxonomies
NY173967207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01839629Medicaid
402B81Medicare PIN