Provider Demographics
NPI:1699981779
Name:SUSAN L. UNGAR, M.D., P.C.
Entity type:Organization
Organization Name:SUSAN L. UNGAR, M.D., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:LISA
Authorized Official - Last Name:UNGAR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:212-787-7546
Mailing Address - Street 1:135 W 70TH ST
Mailing Address - Street 2:SUITE 1K
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10023-4458
Mailing Address - Country:US
Mailing Address - Phone:212-787-7546
Mailing Address - Fax:212-787-7545
Practice Address - Street 1:135 W 70TH ST
Practice Address - Street 2:SUITE 1K
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10023-4458
Practice Address - Country:US
Practice Address - Phone:212-787-7546
Practice Address - Fax:212-787-7545
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-15
Last Update Date:2008-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY191425207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty