Provider Demographics
NPI:1942464581
Name:BOUCREE, SUELYN CLAUDIA (MD)
Entity Type:Individual
Prefix:
First Name:SUELYN
Middle Name:CLAUDIA
Last Name:BOUCREE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:SUELYN
Other - Middle Name:CLAUDIA
Other - Last Name:YOUNG
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:20 PROSPECT AVE.
Mailing Address - Street 2:STE 715
Mailing Address - City:HACKENSACK
Mailing Address - State:NJ
Mailing Address - Zip Code:07601-1989
Mailing Address - Country:US
Mailing Address - Phone:551-996-5585
Mailing Address - Fax:551-996-0444
Practice Address - Street 1:20 PROSPECT AVE.
Practice Address - Street 2:STE 715
Practice Address - City:HACKENSACK
Practice Address - State:NJ
Practice Address - Zip Code:07601-1989
Practice Address - Country:US
Practice Address - Phone:551-996-5585
Practice Address - Fax:551-996-0444
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-14
Last Update Date:2022-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME113414207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine