Provider Demographics
NPI:1316026321
Name:PEDRO A. SUAREZ, MD
Entity Type:Organization
Organization Name:PEDRO A. SUAREZ, MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:
Authorized Official - First Name:PEDRO
Authorized Official - Middle Name:
Authorized Official - Last Name:SUAREZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:631-435-2781
Mailing Address - Street 1:5 WICKS RD
Mailing Address - Street 2:SUITE 1B
Mailing Address - City:BRENTWOOD
Mailing Address - State:NY
Mailing Address - Zip Code:11717-3508
Mailing Address - Country:US
Mailing Address - Phone:631-435-2781
Mailing Address - Fax:631-435-2783
Practice Address - Street 1:5 WICKS RD
Practice Address - Street 2:SUITE 1B
Practice Address - City:BRENTWOOD
Practice Address - State:NY
Practice Address - Zip Code:11717-3508
Practice Address - Country:US
Practice Address - Phone:631-435-2781
Practice Address - Fax:631-435-2783
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-02
Last Update Date:2008-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY153548208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty