Provider Demographics
NPI:1790814341
Name:PAUL, SUZANNE (CRT)
Entity Type:Individual
Prefix:MS
First Name:SUZANNE
Middle Name:
Last Name:PAUL
Suffix:
Gender:F
Credentials:CRT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2308 MEZZIO RD
Mailing Address - Street 2:
Mailing Address - City:FORESTVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14062-9600
Mailing Address - Country:US
Mailing Address - Phone:716-965-4234
Mailing Address - Fax:
Practice Address - Street 1:15 W LUCAS AVE
Practice Address - Street 2:
Practice Address - City:DUNKIRK
Practice Address - State:NY
Practice Address - Zip Code:14048-3340
Practice Address - Country:US
Practice Address - Phone:716-366-1616
Practice Address - Fax:716-366-8830
Is Sole Proprietor?:No
Enumeration Date:2007-03-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY00297227800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes227800000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, Certified
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY002967OtherLICENSE NUMBER