Provider Demographics
NPI:1518180736
Name:ZEZELIC, SUZANNE KAREN (PT)
Entity Type:Individual
Prefix:MRS
First Name:SUZANNE
Middle Name:KAREN
Last Name:ZEZELIC
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27 WASHINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:SETAUKET
Mailing Address - State:NY
Mailing Address - Zip Code:11733-1124
Mailing Address - Country:US
Mailing Address - Phone:631-689-7828
Mailing Address - Fax:631-689-0359
Practice Address - Street 1:27 WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:SETAUKET
Practice Address - State:NY
Practice Address - Zip Code:11733-1124
Practice Address - Country:US
Practice Address - Phone:631-689-7828
Practice Address - Fax:631-689-0359
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY01518901225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist