Provider Demographics
NPI:1881779239
Name:LAI, SUSAN C (RN NP)
Entity type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:C
Last Name:LAI
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Gender:F
Credentials:RN NP
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Mailing Address - Street 1:20910 23RD AVENUE
Mailing Address - Street 2:BH
Mailing Address - City:BAYSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11360-1839
Mailing Address - Country:US
Mailing Address - Phone:718-423-1915
Mailing Address - Fax:718-918-7701
Practice Address - Street 1:1400 PELHAM PARKWAY
Practice Address - Street 2:BLDG 5 RM 312 JACOBI MEDICAL CENTER
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10461
Practice Address - Country:US
Practice Address - Phone:718-918-6021
Practice Address - Fax:718-918-7701
Is Sole Proprietor?:No
Enumeration Date:2006-10-26
Last Update Date:2007-07-08
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Provider Licenses
StateLicense IDTaxonomies
NYF3006071363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
S51706Medicare UPIN