Provider Demographics
NPI:1770138240
Name:UNGAR, SUSAN RAQUEL
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:RAQUEL
Last Name:UNGAR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:SHOSHANA
Other - Middle Name:
Other - Last Name:UNGAR
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:7238 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11367-2408
Mailing Address - Country:US
Mailing Address - Phone:718-851-3300
Mailing Address - Fax:718-261-3702
Practice Address - Street 1:1222 BAY 25TH ST
Practice Address - Street 2:
Practice Address - City:FAR ROCKAWAY
Practice Address - State:NY
Practice Address - Zip Code:11691-1764
Practice Address - Country:US
Practice Address - Phone:718-327-1474
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-01
Last Update Date:2019-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator