Healthcare Provider Details

I. General information

NPI: 1497213029
Provider Name (Legal Business Name): YUKARI SUZUKI PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/02/2019
Last Update Date: 05/31/2023
Certification Date: 05/31/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

165 SMITH ST
BROOKLYN NY
11201-6337
US

IV. Provider business mailing address

129 W 29TH ST FL 10
NEW YORK NY
10001-5105
US

V. Phone/Fax

Practice location:
  • Phone: 212-441-4380
  • Fax: 212-867-4353
Mailing address:
  • Phone: 415-658-6791
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number023326
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: