Provider Demographics
NPI:1447906912
Name:BOGDANOWICH, SUZANNE MARIE (LMT)
Entity type:Individual
Prefix:
First Name:SUZANNE
Middle Name:MARIE
Last Name:BOGDANOWICH
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:SUZANNE
Other - Middle Name:MARIE
Other - Last Name:MURDOCK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMT
Mailing Address - Street 1:30 LEE AVE
Mailing Address - Street 2:
Mailing Address - City:PATCHOGUE
Mailing Address - State:NY
Mailing Address - Zip Code:11772-3623
Mailing Address - Country:US
Mailing Address - Phone:631-672-1616
Mailing Address - Fax:
Practice Address - Street 1:1461 LAKELAND AVE UNIT 9
Practice Address - Street 2:
Practice Address - City:BOHEMIA
Practice Address - State:NY
Practice Address - Zip Code:11716-2174
Practice Address - Country:US
Practice Address - Phone:631-467-8224
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-02-23
Last Update Date:2022-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY024013-01225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist