Provider Demographics
NPI:1720398019
Name:SUAREZ, RICARDO (DPT)
Entity Type:Individual
Prefix:
First Name:RICARDO
Middle Name:
Last Name:SUAREZ
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1999 MARCUS AVE
Mailing Address - Street 2:SUITE M-15
Mailing Address - City:NEW HYDE PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11042-1017
Mailing Address - Country:US
Mailing Address - Phone:516-488-8808
Mailing Address - Fax:516-488-8818
Practice Address - Street 1:1999 MARCUS AVE
Practice Address - Street 2:SUITE M-15
Practice Address - City:NEW HYDE PARK
Practice Address - State:NY
Practice Address - Zip Code:11042-1017
Practice Address - Country:US
Practice Address - Phone:516-488-8808
Practice Address - Fax:516-488-8818
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-20
Last Update Date:2010-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY028071-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist