Provider Demographics
NPI:1841257193
Name:ETTINGER, SUELLEN P (PT)
Entity type:Individual
Prefix:MRS
First Name:SUELLEN
Middle Name:P
Last Name:ETTINGER
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 1:370 E 76TH ST
Mailing Address - Street 2:APT B1702
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10021
Mailing Address - Country:US
Mailing Address - Phone:212-734-5530
Mailing Address - Fax:
Practice Address - Street 1:21 W 86TH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10024-3671
Practice Address - Country:US
Practice Address - Phone:212-580-0125
Practice Address - Fax:212-580-0860
Is Sole Proprietor?:No
Enumeration Date:2006-04-28
Last Update Date:2009-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY002398225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYQ43941OtherEMPIRE BCBS