Individual
SUSAN K BOOLBOL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
2101701
NY
208600000X
Surgery Physician
67054
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
02169877
—
NY
Enumeration date
12/06/2005
Last updated
12/06/2021
Update your record
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