Provider Demographics
NPI:1275595605
Name:KREIENBERG, SUZANNE ELISABETH (MD)
Entity Type:Individual
Prefix:DR
First Name:SUZANNE
Middle Name:ELISABETH
Last Name:KREIENBERG
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:319 S MANNING BLVD
Mailing Address - Street 2:SUITE 210
Mailing Address - City:ALBANY
Mailing Address - State:NY
Mailing Address - Zip Code:12208-1742
Mailing Address - Country:US
Mailing Address - Phone:518-641-6936
Mailing Address - Fax:518-641-6939
Practice Address - Street 1:319 S MANNING BLVD
Practice Address - Street 2:SUITE 210
Practice Address - City:ALBANY
Practice Address - State:NY
Practice Address - Zip Code:12208-1742
Practice Address - Country:US
Practice Address - Phone:518-641-6936
Practice Address - Fax:518-641-6939
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY198409208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01945073Medicaid
NY01945073Medicaid
BB6305Medicare ID - Type Unspecified