Provider Demographics
NPI:1699732891
Name:KEMKER, SUSAN S (MD)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:S
Last Name:KEMKER
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:NYMC BEHAVIORAL HEALTH CENTER N326
Mailing Address - Street 2:20 HOSPITAL ROAD
Mailing Address - City:VALHALLA
Mailing Address - State:NY
Mailing Address - Zip Code:10595
Mailing Address - Country:US
Mailing Address - Phone:914-493-7124
Mailing Address - Fax:914-493-1015
Practice Address - Street 1:NYMC BEHAVIORAL HEALTH CENTER N326
Practice Address - Street 2:20 HOSPITAL ROAD
Practice Address - City:VALHALLA
Practice Address - State:NY
Practice Address - Zip Code:10595
Practice Address - Country:US
Practice Address - Phone:914-493-7124
Practice Address - Fax:914-493-1015
Is Sole Proprietor?:No
Enumeration Date:2006-05-01
Last Update Date:2014-02-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY1638492084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01130450Medicaid
NY01130450Medicaid
NYD91925Medicare UPIN