Healthcare Provider Details

I. General information

NPI: 1891457461
Provider Name (Legal Business Name): SUZANNE SMOLINSKY LMT, LE, EMT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/11/2021
Last Update Date: 10/11/2021
Certification Date: 10/10/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

663 ORANGE CENTER RD
ORANGE CT
06477-2400
US

IV. Provider business mailing address

663 ORANGE CENTER RD UNIT 2
ORANGE CT
06477-2400
US

V. Phone/Fax

Practice location:
  • Phone: 475-731-8279
  • Fax:
Mailing address:
  • Phone: 475-731-8279
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code146N00000X
TaxonomyBasic Emergency Medical Technician
License Number12053
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number16731
License Number StateMA
# 3
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number10423
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: