Provider Demographics
NPI:1841325628
Name:KIRBY, SUZANNE JAYNE (DC)
Entity type:Individual
Prefix:DR
First Name:SUZANNE
Middle Name:JAYNE
Last Name:KIRBY
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1448
Mailing Address - Street 2:
Mailing Address - City:SAG HARBOR
Mailing Address - State:NY
Mailing Address - Zip Code:11963
Mailing Address - Country:US
Mailing Address - Phone:631-725-3398
Mailing Address - Fax:631-725-6302
Practice Address - Street 1:3334 NOYAC RD
Practice Address - Street 2:
Practice Address - City:SAG HARBOR
Practice Address - State:NY
Practice Address - Zip Code:11963
Practice Address - Country:US
Practice Address - Phone:631-725-3398
Practice Address - Fax:631-725-6302
Is Sole Proprietor?:No
Enumeration Date:2007-02-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX0049471111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYX27091Medicare ID - Type Unspecified