Individual
KELLY JENNIFER SUAREZ
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
480 RED HILL RD, MIDDLETOWN, NJ 07748
(848) 225-6331
(212) 717-3169
Mailing address
231 GODWIN AVE UNIT 1, RIDGEWOOD, NJ 07450-3709
(786) 296-2309
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
PA9105022
FL
363AS0400X
Surgical Physician Assistant
Primary
25MP00465900
NJ
Other
Enumeration date
05/17/2010
Last updated
08/23/2018
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