Provider Demographics
NPI:1841614369
Name:GREENBAUM, SUSAN
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:
Last Name:GREENBAUM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:SUSAN
Other - Middle Name:MARION
Other - Last Name:TUCK
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:6 KATIE LN
Mailing Address - Street 2:
Mailing Address - City:MAMARONECK
Mailing Address - State:NY
Mailing Address - Zip Code:10543-1045
Mailing Address - Country:US
Mailing Address - Phone:914-698-3592
Mailing Address - Fax:
Practice Address - Street 1:6 KATIE LN
Practice Address - Street 2:
Practice Address - City:MAMARONECK
Practice Address - State:NY
Practice Address - Zip Code:10543-1045
Practice Address - Country:US
Practice Address - Phone:914-698-3592
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-05
Last Update Date:2014-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1198882085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology