Provider Demographics
NPI:1447526686
Name:SUAREZ, MICHAEL
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:
Last Name:SUAREZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:540 TUCKAHOE RD
Mailing Address - Street 2:1A
Mailing Address - City:YONKERS
Mailing Address - State:NY
Mailing Address - Zip Code:10710-5719
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:540 TUCKAHOE RD
Practice Address - Street 2:1A
Practice Address - City:YONKERS
Practice Address - State:NY
Practice Address - Zip Code:10710-5719
Practice Address - Country:US
Practice Address - Phone:914-525-4332
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-30
Last Update Date:2012-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY605832121252Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency