MEDICARE: SUZANNE FISCHER LMT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225700000X	Massage Therapist	016403	NY

General Provider Information

NPI Number	:	1407327018
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SUZANNE FISCHER LMT

Provider Business Mailing Address
First Line	:	10 FORT SALONGA RD STE 2A
Second Line	:
City	:	FORT SALONGA
State	:	NY
Zip	:	11768-1465
Country	:	US
Telephone Number	:	631-343-7174
Fax Number	:

Provider Business Practice Location Address
First Line	:	10 FORT SALONGA RD STE 2A
Second Line	:
City	:	FORT SALONGA
State	:	NY
Zip	:	11768-1465
Country	:	US
Telephone Number	:	631-343-7174
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/07/2018
Last Update Date	:	06/11/2019

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Directions to “ SUZANNE FISCHER LMT” Practice Location

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