Provider Demographics
NPI:1831195239
Name:REGISFORD, SUSAN HEATHER DAUN (MD)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:HEATHER DAUN
Last Name:REGISFORD
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 1436
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10163-1436
Mailing Address - Country:US
Mailing Address - Phone:212-983-0246
Mailing Address - Fax:
Practice Address - Street 1:380 2ND AVE
Practice Address - Street 2:CONCOURSE A
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10010-5615
Practice Address - Country:US
Practice Address - Phone:212-375-1065
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-06-22
Last Update Date:2012-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY186806207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology