Provider Demographics
NPI:1457436677
Name:BOKA, SUZANNA P (MD)
Entity Type:Individual
Prefix:
First Name:SUZANNA
Middle Name:P
Last Name:BOKA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 PINNACLE PLACE
Mailing Address - Street 2:STE 203
Mailing Address - City:ALBANY
Mailing Address - State:NY
Mailing Address - Zip Code:12203
Mailing Address - Country:US
Mailing Address - Phone:518-438-4700
Mailing Address - Fax:518-438-3190
Practice Address - Street 1:1 PINNACLE PLACE
Practice Address - Street 2:STE 203
Practice Address - City:ALBANY
Practice Address - State:NY
Practice Address - Zip Code:12203
Practice Address - Country:US
Practice Address - Phone:518-438-4700
Practice Address - Fax:518-438-3190
Is Sole Proprietor?:No
Enumeration Date:2006-10-26
Last Update Date:2008-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY216489207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02112696Medicaid
SB0364J210OtherBCBS
NY02112696Medicaid
G09013Medicare UPIN
NYCC5056Medicare PIN