Provider Demographics
NPI:1518062512
Name:SUAREZ, FERNANDO LEON (PHYSICAL THERAPY)
Entity Type:Individual
Prefix:MR
First Name:FERNANDO
Middle Name:LEON
Last Name:SUAREZ
Suffix:
Gender:M
Credentials:PHYSICAL THERAPY
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7215 GRAND AVE
Mailing Address - Street 2:
Mailing Address - City:MASPETH
Mailing Address - State:NY
Mailing Address - Zip Code:11378-1525
Mailing Address - Country:US
Mailing Address - Phone:718-803-2058
Mailing Address - Fax:718-426-9155
Practice Address - Street 1:7215 GRAND AVE
Practice Address - Street 2:
Practice Address - City:MASPETH
Practice Address - State:NY
Practice Address - Zip Code:11378-1525
Practice Address - Country:US
Practice Address - Phone:718-803-2058
Practice Address - Fax:718-426-9155
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-14
Last Update Date:2024-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY012637225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1518062512Medicare NSC