=====================================================
General NPI Number Information
=====================================================
NPI Number | 1740858661
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | PAULINE CLAIRE P SUAN PT
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/16/2021
-----------------------------------------------------
Last Update Date | 04/26/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 15 PROSPECT LN STE 1D
-----------------------------------------------------
City | COLONIA
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07067-3048
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 732-827-0028
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1311 MAMARONECK AVE STE 140
-----------------------------------------------------
City | WHITE PLAINS
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10605-5224
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 888-830-4125
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225100000X
-----------------------------------------------------
Taxonomy Name | Physical Therapist
-----------------------------------------------------
License Number | 40QA02001700
-----------------------------------------------------
License Number State | NJ
-----------------------------------------------------