Provider Demographics
NPI:1659460566
Name:SUTERA, JACQUELINE M (DPM)
Entity Type:Individual
Prefix:DR
First Name:JACQUELINE
Middle Name:M
Last Name:SUTERA
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:57 WEST 57TH STREET
Mailing Address - Street 2:STE 1201
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10019-9430
Mailing Address - Country:US
Mailing Address - Phone:716-456-8027
Mailing Address - Fax:212-755-3676
Practice Address - Street 1:57 WEST 57TH STREET
Practice Address - Street 2:STE 1201
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10019-9430
Practice Address - Country:US
Practice Address - Phone:716-456-8027
Practice Address - Fax:212-755-3676
Is Sole Proprietor?:No
Enumeration Date:2006-10-11
Last Update Date:2023-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN006030-2213ES0131X
NJ25MD00279500213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYU99984Medicare UPIN
NJ085081Medicare PIN
PJ3421Medicare ID - Type Unspecified