Basic Information
Provider Information
NPI: 1104853324
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: LENTZSCH
FirstName: SUZANNE
MiddleName:  
NamePrefix: DR.
NameSuffix:  
Credential: MD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 630 W 168TH ST
Address2: BOX 4
City: NEW YORK
State: NY
PostalCode: 100323725
CountryCode: US
TelephoneNumber: 6463174840
FaxNumber: 2123056762
Practice Location
Address1: 622 W 168TH ST
Address2:  
City: NEW YORK
State: NY
PostalCode: 100323720
CountryCode: US
TelephoneNumber: 2123055098
FaxNumber:  
Other Information
ProviderEnumerationDate: 06/26/2006
LastUpdateDate: 06/14/2016
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: Y
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207RH0003XMD428607PAN Allopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
207RH0003X263244NYY Allopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology

No ID Information.


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