Provider Demographics
NPI:1588807309
Name:JELOVECKI, SUZANA (LAC)
Entity Type:Individual
Prefix:
First Name:SUZANA
Middle Name:
Last Name:JELOVECKI
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:185 MIDLINE RD
Mailing Address - Street 2:
Mailing Address - City:SLATERVILLE SPRINGS
Mailing Address - State:NY
Mailing Address - Zip Code:14881-9411
Mailing Address - Country:US
Mailing Address - Phone:607-539-3263
Mailing Address - Fax:
Practice Address - Street 1:185 MIDLINE RD
Practice Address - Street 2:
Practice Address - City:SLATERVILLE SPRINGS
Practice Address - State:NY
Practice Address - Zip Code:14881-9411
Practice Address - Country:US
Practice Address - Phone:607-539-3263
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-04-08
Last Update Date:2009-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY004006171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist