Provider Demographics
NPI:1568724474
Name:GARCIA RENNELLA, SUZETTE (MS)
Entity Type:Individual
Prefix:MRS
First Name:SUZETTE
Middle Name:
Last Name:GARCIA RENNELLA
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22 BALDWIN AVE
Mailing Address - Street 2:
Mailing Address - City:MASSAPEQUA
Mailing Address - State:NY
Mailing Address - Zip Code:11758-7237
Mailing Address - Country:US
Mailing Address - Phone:516-375-6476
Mailing Address - Fax:
Practice Address - Street 1:22 BALDWIN AVE
Practice Address - Street 2:
Practice Address - City:MASSAPEQUA
Practice Address - State:NY
Practice Address - Zip Code:11758-7237
Practice Address - Country:US
Practice Address - Phone:516-375-6476
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-06-15
Last Update Date:2012-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist