Provider Demographics
NPI:1144038175
Name:LANDIS KACZOR, SUZANNE
Entity type:Individual
Prefix:
First Name:SUZANNE
Middle Name:
Last Name:LANDIS KACZOR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:713 COWPATH RD
Mailing Address - Street 2:
Mailing Address - City:TELFORD
Mailing Address - State:PA
Mailing Address - Zip Code:18969-2151
Mailing Address - Country:US
Mailing Address - Phone:610-724-4728
Mailing Address - Fax:
Practice Address - Street 1:4023 BETHLEHEM PIKE
Practice Address - Street 2:
Practice Address - City:TELFORD
Practice Address - State:PA
Practice Address - Zip Code:18969-1126
Practice Address - Country:US
Practice Address - Phone:610-724-4728
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-12-23
Last Update Date:2024-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAAK001033171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist