Provider Demographics
NPI:1356553796
Name:SUAREZ-IAVARONE, MELBA OCAMPO (PT)
Entity type:Individual
Prefix:MRS
First Name:MELBA
Middle Name:OCAMPO
Last Name:SUAREZ-IAVARONE
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 1:3935 51ST ST APT 4F
Mailing Address - Street 2:
Mailing Address - City:WOODSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11377-3168
Mailing Address - Country:US
Mailing Address - Phone:718-440-7709
Mailing Address - Fax:718-606-9733
Practice Address - Street 1:24 5TH AVE APT 1112
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10011-8820
Practice Address - Country:US
Practice Address - Phone:917-685-9334
Practice Address - Fax:212-228-2052
Is Sole Proprietor?:No
Enumeration Date:2007-05-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY021408-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYQ23C51Medicare ID - Type UnspecifiedEMPIRE MEDICARE