Provider Demographics
NPI:1548267511
Name:STEIN, SUSAN KAY (DO)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:KAY
Last Name:STEIN
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19 BRADHURST AVE STE 3100N
Mailing Address - Street 2:
Mailing Address - City:HAWTHORNE
Mailing Address - State:NY
Mailing Address - Zip Code:10532-2140
Mailing Address - Country:US
Mailing Address - Phone:914-909-9018
Mailing Address - Fax:914-909-9028
Practice Address - Street 1:105 MARYS AVE
Practice Address - Street 2:
Practice Address - City:KINGSTON
Practice Address - State:NY
Practice Address - Zip Code:12401-5829
Practice Address - Country:US
Practice Address - Phone:845-338-2500
Practice Address - Fax:845-483-5000
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-05
Last Update Date:2021-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO29088207L00000X, 207L00000X
MN38070207L00000X
MT8813207L00000X
UT4904017-1204207L00000X
NY173913207L00000X
WY6978A207L00000X
VT032-0000339207L00000X
MA209439207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY10027331OtherCDPHP
MN947222300OtherMN MEDICAL ASSISTANCE
CO992-411-01OtherBC/BS
VT205-8339OtherBC/BS
CO01290881Medicaid
NH30222127Medicaid
MN21947Medicare ID - Type Unspecified
NY10027331OtherCDPHP
E56961Medicare UPIN
NY01240519Medicare ID - Type Unspecified
CO992-411-01OtherBC/BS