Individual
TIFFANY SUWOTO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
1468 MADISON AVE, NEW YORK, NY 10029-6508
(212) 241-6741
Mailing address
215 PARK ROW APT 21G, NEW YORK, NY 10038-1128
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
030967
NY
Other
Enumeration date
07/22/2024
Last updated
07/23/2024
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