MEDICARE: GEN SUZUKI MD, PHD

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	293D00000X	Physiological Laboratory	NA	NY

General Provider Information

NPI Number	:	1528397445
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GEN SUZUKI MD, PHD

Provider Business Mailing Address
First Line	:	3415 MAIN STREET
Second Line	:	RM347 BRB
City	:	BUFFALO
State	:	NY
Zip	:	14214
Country	:	US
Telephone Number	:	716-829-2710
Fax Number	:

Provider Business Practice Location Address
First Line	:	3415 MAIN STREET
Second Line	:	RM347 BRB
City	:	BUFFALO
State	:	NY
Zip	:	14214
Country	:	US
Telephone Number	:	716-829-2710
Fax Number	:

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

Provider Enumeration Date	:	12/24/2009
Last Update Date	:	12/24/2009

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