Provider Demographics
NPI:1740254234
Name:RICE, SUSAN MARIE (DPM)
Entity type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:MARIE
Last Name:RICE
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 CENTRAL AVE
Mailing Address - Street 2:SUITE 301
Mailing Address - City:TARRYTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:10591-3350
Mailing Address - Country:US
Mailing Address - Phone:914-631-3166
Mailing Address - Fax:914-631-4513
Practice Address - Street 1:1 CENTRAL AVE
Practice Address - Street 2:SUITE 301
Practice Address - City:TARRYTOWN
Practice Address - State:NY
Practice Address - Zip Code:10591-3350
Practice Address - Country:US
Practice Address - Phone:914-631-3166
Practice Address - Fax:914-631-4513
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN004426213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYP50621Medicare ID - Type Unspecified
NYU18032Medicare UPIN