Provider Demographics
NPI:1093909780
Name:SUITE E, INC.
Entity Type:Organization
Organization Name:SUITE E, INC.
Other - Org Name:JODI LOWRY
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:JODI
Authorized Official - Middle Name:SUE
Authorized Official - Last Name:LOWRY
Authorized Official - Suffix:
Authorized Official - Credentials:L-CSW-R
Authorized Official - Phone:607-729-3003
Mailing Address - Street 1:3209 VESTAL PKWY
Mailing Address - Street 2:SUITE E
Mailing Address - City:VESTAL
Mailing Address - State:NY
Mailing Address - Zip Code:13850-2154
Mailing Address - Country:US
Mailing Address - Phone:607-729-3003
Mailing Address - Fax:607-729-3004
Practice Address - Street 1:3209 VESTAL PKWY
Practice Address - Street 2:SUITE E
Practice Address - City:VESTAL
Practice Address - State:NY
Practice Address - Zip Code:13850-2154
Practice Address - Country:US
Practice Address - Phone:607-729-3003
Practice Address - Fax:607-729-3004
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-05
Last Update Date:2007-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR053915261QM0850X, 261QM0855X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYCC1101Medicare UPIN