Healthcare Provider Details

I. General information

NPI: 1922656552
Provider Name (Legal Business Name): JOSE LUIS SUAREZ TIONGKO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/27/2019
Last Update Date: 05/30/2025
Certification Date: 05/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 COOPER PLZ
CAMDEN NJ
08103-1461
US

IV. Provider business mailing address

1040 CLIFTON AVE
CLIFTON NJ
07013-3526
US

V. Phone/Fax

Practice location:
  • Phone: 800-826-6737
  • Fax:
Mailing address:
  • Phone: 347-722-1410
  • Fax: 906-208-2273

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number318832
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number07517820
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: