Individual
SUSI VASSALLO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
550 1ST AVE, NEW YORK, NY 10016-6402
(212) 263-3293
Mailing address
550 1ST AVE, NEW YORK, NY 10016-6402
(212) 263-3293
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
170778
NY
207P00000X
Emergency Medicine Physician
170778
NY
207PT0002X
Medical Toxicology (Emergency Medicine) Physician
Primary
170778
NY
Other
Enumeration date
08/29/2005
Last updated
09/20/2022
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