Provider Demographics
NPI:1194260968
Name:CABASSA, SUAJIRY
Entity type:Individual
Prefix:
First Name:SUAJIRY
Middle Name:
Last Name:CABASSA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:315 E 102ND ST
Mailing Address - Street 2:APT 418
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10029-5613
Mailing Address - Country:US
Mailing Address - Phone:646-399-1293
Mailing Address - Fax:212-369-4394
Practice Address - Street 1:315 E 102ND ST
Practice Address - Street 2:APT 418
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10029-5613
Practice Address - Country:US
Practice Address - Phone:646-399-1293
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-01-03
Last Update Date:2017-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator