Individual
DR. JONATHAN SUSMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
622 W 168TH ST, NEW YORK, NY 10032-3720
(212) 305-9335
(212) 305-8636
Mailing address
622 W 168TH ST, MC# 28, NEW YORK, NY 10032-3720
(212) 305-1948
(212) 305-5777
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
203180-1
NY
2085R0204X
Vascular & Interventional Radiology Physician
Primary
203180-1
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
02007454
—
NY
01
—
02186161
MEDICAID GROUP#
NY
01
—
02186203
MEDICAID GROUP#
NY
01
—
1467560854
GROUP NPI #
NY
01
—
1992816011
GROUP NPI#
NY
01
—
W34991
MEDICARE GROUP#
NY
01
—
W35021
MEDICARE GROUP#
NY
Enumeration date
07/07/2006
Last updated
02/08/2008
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