Healthcare Provider Details

I. General information

NPI: 1841431681
Provider Name (Legal Business Name): SUZETTE GORE L.OM.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/06/2009
Last Update Date: 03/06/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

940 TOWN CENTER DR SUITE F-90
LANGHORNE PA
19047-1772
US

IV. Provider business mailing address

1408 DIAMOND DR
NEWTOWN PA
18940-2428
US

V. Phone/Fax

Practice location:
  • Phone: 215-397-8963
  • Fax:
Mailing address:
  • Phone: 215-397-8963
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberOM000043
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: