Provider Demographics
NPI:1922104462
Name:SURESKY, LOIS H (PT)
Entity Type:Individual
Prefix:
First Name:LOIS
Middle Name:H
Last Name:SURESKY
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 795
Mailing Address - Street 2:
Mailing Address - City:RENSSELAER
Mailing Address - State:NY
Mailing Address - Zip Code:12144-0795
Mailing Address - Country:US
Mailing Address - Phone:518-479-0024
Mailing Address - Fax:518-479-0962
Practice Address - Street 1:3262 MARILYN ST
Practice Address - Street 2:
Practice Address - City:SCHENECTADY
Practice Address - State:NY
Practice Address - Zip Code:12303-4714
Practice Address - Country:US
Practice Address - Phone:518-505-3017
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-15
Last Update Date:2009-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0035941225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00310361Medicaid
NY000404582001OtherBS OF NENY
NY10002007OtherCDPHP
NY00310361Medicaid
NY000404582001OtherBS OF NENY
NY10002007OtherCDPHP
NYJ300000016Medicare PIN