Provider Demographics
NPI:1942652342
Name:SUCHECKA, ELIZABETH (MS SP ED)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:
Last Name:SUCHECKA
Suffix:
Gender:F
Credentials:MS SP ED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7909 WOODHAVEN BLVD
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:NY
Mailing Address - Zip Code:11385-8053
Mailing Address - Country:US
Mailing Address - Phone:646-642-5946
Mailing Address - Fax:
Practice Address - Street 1:7909 WOODHAVEN BLVD
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:NY
Practice Address - Zip Code:11385-8053
Practice Address - Country:US
Practice Address - Phone:646-642-5946
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-07-08
Last Update Date:2016-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY283655390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program