Provider Demographics
NPI:1104818707
Name:DAYE, SUSANNE (MD)
Entity type:Individual
Prefix:DR
First Name:SUSANNE
Middle Name:
Last Name:DAYE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:SUSANNE
Other - Middle Name:
Other - Last Name:DAYE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:1571 WASHINGTON ST
Mailing Address - Street 2:SUITE 101
Mailing Address - City:WATERTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:13601-9304
Mailing Address - Country:US
Mailing Address - Phone:315-786-5046
Mailing Address - Fax:315-786-5043
Practice Address - Street 1:1571 WASHINGTON ST
Practice Address - Street 2:SUITE 101
Practice Address - City:WATERTOWN
Practice Address - State:NY
Practice Address - Zip Code:13601-9304
Practice Address - Country:US
Practice Address - Phone:315-786-5046
Practice Address - Fax:315-786-5043
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-19
Last Update Date:2014-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1744242085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01892593Medicaid
NY01892593Medicaid
NYP00306804Medicare PIN
NYRA4237Medicare PIN
NYIA1252Medicare PIN
NYF86952Medicare UPIN
NYRA4238Medicare PIN