Provider Demographics
NPI:1689736993
Name:SUAREZ, LYNETTE G (MD)
Entity Type:Individual
Prefix:DR
First Name:LYNETTE
Middle Name:G
Last Name:SUAREZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:360 BLOOMFIELD AVE
Mailing Address - Street 2:
Mailing Address - City:CALDWELL
Mailing Address - State:NJ
Mailing Address - Zip Code:07006-4905
Mailing Address - Country:US
Mailing Address - Phone:973-226-8464
Mailing Address - Fax:973-226-3750
Practice Address - Street 1:360 BLOOMFIELD AVE
Practice Address - Street 2:
Practice Address - City:CALDWELL
Practice Address - State:NJ
Practice Address - Zip Code:07006-4905
Practice Address - Country:US
Practice Address - Phone:973-226-8464
Practice Address - Fax:973-226-3750
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-14
Last Update Date:2010-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA05437900207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0K5503OtherHEALTHNET
NJ4569202Medicaid
NJP753127OtherOXFORD
NJ687631Medicare ID - Type Unspecified
NJ4569202Medicaid