Provider Demographics
NPI:1912158163
Name:BOHNE, SUSAN
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:
Last Name:BOHNE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:353 E 83RD ST
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10028-4337
Mailing Address - Country:US
Mailing Address - Phone:212-249-6301
Mailing Address - Fax:
Practice Address - Street 1:2900 BEDFORD AVE
Practice Address - Street 2:4400 BOYLAN HALL
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11210-2850
Practice Address - Country:US
Practice Address - Phone:718-951-5186
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-07
Last Update Date:2008-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2110235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist