Provider Demographics
NPI:1194918953
Name:SUSAN GARDINER, PSYCHIATRIST,, P.C.
Entity type:Organization
Organization Name:SUSAN GARDINER, PSYCHIATRIST,, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:
Authorized Official - Last Name:GARDINER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:518-475-1909
Mailing Address - Street 1:34 LONGWOOD DR
Mailing Address - Street 2:
Mailing Address - City:DELMAR
Mailing Address - State:NY
Mailing Address - Zip Code:12054-3737
Mailing Address - Country:US
Mailing Address - Phone:518-475-1909
Mailing Address - Fax:
Practice Address - Street 1:785 DELAWARE AVE
Practice Address - Street 2:
Practice Address - City:DELMAR
Practice Address - State:NY
Practice Address - Zip Code:12054-9713
Practice Address - Country:US
Practice Address - Phone:518-439-1693
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-23
Last Update Date:2007-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2276212084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYH96347Medicare UPIN