Provider Demographics
NPI:1316996846
Name:PLATKIN, SUSAN PAULA (MD)
Entity type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:PAULA
Last Name:PLATKIN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:25 KIMBERLY DR
Mailing Address - Street 2:
Mailing Address - City:E NORTHPORT
Mailing Address - State:NY
Mailing Address - Zip Code:11731-3305
Mailing Address - Country:US
Mailing Address - Phone:631-266-1743
Mailing Address - Fax:
Practice Address - Street 1:285 SILLS RD
Practice Address - Street 2:BLDG.15, STE D
Practice Address - City:EAST PATCHOGUE
Practice Address - State:NY
Practice Address - Zip Code:11772-4869
Practice Address - Country:US
Practice Address - Phone:631-758-6900
Practice Address - Fax:631-758-1926
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY146090174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYB19512Medicare UPIN