Basic Information
Provider Information
NPI: 1255641569
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: SCHAEFER
FirstName: SUSAN
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential: OT
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 1255 5TH AVE
Address2: SUITE 6L
City: NEW YORK
State: NY
PostalCode: 100293852
CountryCode: US
TelephoneNumber: 9144001500
FaxNumber: 9144788781
Practice Location
Address1: 1015 SAW MILL RIVER RD
Address2:  
City: ARDSLEY
State: NY
PostalCode: 105021118
CountryCode: US
TelephoneNumber: 9144001500
FaxNumber: 9144788781
Other Information
ProviderEnumerationDate: 10/20/2010
LastUpdateDate: 10/20/2010
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
225X00000X006595-1NYY Respiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist 

No ID Information.


Home