Provider Demographics
NPI:1174954796
Name:BLACK, SUZANNE (DVM)
Entity type:Individual
Prefix:
First Name:SUZANNE
Middle Name:
Last Name:BLACK
Suffix:
Gender:F
Credentials:DVM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1112 MORTON BLVD
Mailing Address - Street 2:
Mailing Address - City:KINGSTON
Mailing Address - State:NY
Mailing Address - Zip Code:12401-1557
Mailing Address - Country:US
Mailing Address - Phone:845-336-0713
Mailing Address - Fax:845-336-0714
Practice Address - Street 1:1112 MORTON BLVD
Practice Address - Street 2:
Practice Address - City:KINGSTON
Practice Address - State:NY
Practice Address - Zip Code:12401-1557
Practice Address - Country:US
Practice Address - Phone:845-336-0713
Practice Address - Fax:845-336-0714
Is Sole Proprietor?:Yes
Enumeration Date:2013-12-07
Last Update Date:2013-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY005292174M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174M00000XOther Service ProvidersVeterinarian