Provider Demographics
NPI:1871701979
Name:CONNOLE, SUZANNE (LAC)
Entity type:Individual
Prefix:
First Name:SUZANNE
Middle Name:
Last Name:CONNOLE
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:250 5TH AVE
Mailing Address - Street 2:SUITE 507
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10001-6405
Mailing Address - Country:US
Mailing Address - Phone:917-620-2790
Mailing Address - Fax:
Practice Address - Street 1:250 5TH AVE
Practice Address - Street 2:SUITE 507
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10001-6405
Practice Address - Country:US
Practice Address - Phone:917-620-2790
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2662171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist