Provider Demographics
NPI:1477687754
Name:ENG-MA, SUSAN S (PA)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:S
Last Name:ENG-MA
Suffix:
Gender:F
Credentials:PA
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Mailing Address - Street 1:7705 SHORE RD
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11209-2809
Mailing Address - Country:US
Mailing Address - Phone:718-715-8674
Mailing Address - Fax:212-966-0072
Practice Address - Street 1:128 MOTT ST
Practice Address - Street 2:405
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10013-5540
Practice Address - Country:US
Practice Address - Phone:212-966-0068
Practice Address - Fax:212-966-0072
Is Sole Proprietor?:No
Enumeration Date:2007-03-16
Last Update Date:2013-03-19
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY004705363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant