MEDICARE: PAULINE CLAIRE P SUAN PT

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	225100000X	Physical Therapist	40QA02001700	NJ

General Provider Information

NPI Number	:	1740858661
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PAULINE CLAIRE P SUAN PT

Provider Business Mailing Address
First Line	:	1311 MAMARONECK AVE STE 140
Second Line	:
City	:	WHITE PLAINS
State	:	NY
Zip	:	10605-5224
Country	:	US
Telephone Number	:	888-830-4125
Fax Number	:

Provider Business Practice Location Address
First Line	:	15 PROSPECT LN STE 1D
Second Line	:
City	:	COLONIA
State	:	NJ
Zip	:	07067-3048
Country	:	US
Telephone Number	:	732-827-0028
Fax Number	:

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

Provider Enumeration Date	:	06/16/2021
Last Update Date	:	04/26/2022

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Directions to “ PAULINE CLAIRE P SUAN PT” Practice Location

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