Healthcare Provider Details

I. General information

NPI: 1477853067
Provider Name (Legal Business Name): SUZANNE MARIE SCARZAFAVA P.T.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/28/2010
Last Update Date: 10/28/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

156 ROUTE 302
PINE BUSH NY
12566
US

IV. Provider business mailing address

P.O. BOX 155 4 BRUSH ROAD
SUMMITVILLE NY
12781
US

V. Phone/Fax

Practice location:
  • Phone: 845-744-2031
  • Fax:
Mailing address:
  • Phone: 845-888-4276
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number000619-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: