MEDICARE: SUZANNE KWASNIEWSKI L.M.T.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225700000X	Massage Therapist

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2780	OTHER	NY	NO FAULT

General Provider Information

NPI Number	:	1417498338
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SUZANNE KWASNIEWSKI L.M.T.

Provider Business Mailing Address
First Line	:	PO BOX 1151
Second Line	:
City	:	SARATOGA SPGS
State	:	NY
Zip	:	12866-0889
Country	:	US
Telephone Number	:	518-265-5473
Fax Number	:

Provider Business Practice Location Address
First Line	:	233 LAKE AVE
Second Line	:
City	:	SARATOGA SPGS
State	:	NY
Zip	:	12866-2729
Country	:	US
Telephone Number	:	518-265-5473
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/10/2017
Last Update Date	:	07/24/2017

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