Provider Demographics
NPI:1841327277
Name:KANSAGRA, SUSAN MANSUKHLAL (MD, MBA)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:MANSUKHLAL
Last Name:KANSAGRA
Suffix:
Gender:F
Credentials:MD, MBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:125 WORTH ST
Mailing Address - Street 2:ROOM 349
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10013-4006
Mailing Address - Country:US
Mailing Address - Phone:212-788-7493
Mailing Address - Fax:
Practice Address - Street 1:125 WORTH ST
Practice Address - Street 2:ROOM 349
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10013-4006
Practice Address - Country:US
Practice Address - Phone:212-788-7493
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-27
Last Update Date:2008-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY249247-1207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine