Healthcare Provider Details

I. General information

NPI: 1427146042
Provider Name (Legal Business Name): SUANNE KOWAL-CONNELLY M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/10/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

55 N OCEAN AVE
FREEPORT NY
11520-3035
US

IV. Provider business mailing address

55 N OCEAN AVE
FREEPORT NY
11520-3035
US

V. Phone/Fax

Practice location:
  • Phone: 516-379-1535
  • Fax: 516-223-4962
Mailing address:
  • Phone: 516-379-1535
  • Fax: 516-223-4962

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080A0000X
TaxonomyPediatric Adolescent Medicine Physician
License Number166957
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: