Provider Demographics
NPI:1124107370
Name:SUAREZ-GARITA, ELIZABETH (OD)
Entity type:Individual
Prefix:DR
First Name:ELIZABETH
Middle Name:
Last Name:SUAREZ-GARITA
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7418 BERGENLINE AVE
Mailing Address - Street 2:PO BOX 9118
Mailing Address - City:NORTH BERGEN
Mailing Address - State:NJ
Mailing Address - Zip Code:07047-5449
Mailing Address - Country:US
Mailing Address - Phone:201-868-1886
Mailing Address - Fax:201-868-7392
Practice Address - Street 1:7418 BERGENLINE AVE
Practice Address - Street 2:
Practice Address - City:NORTH BERGEN
Practice Address - State:NJ
Practice Address - Zip Code:07047-5449
Practice Address - Country:US
Practice Address - Phone:201-868-1886
Practice Address - Fax:201-868-7392
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ27OA00537800152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJU56800Medicare UPIN