Provider Demographics
NPI:1316947419
Name:SUCKNO, LEE JEFFREY (MD)
Entity type:Individual
Prefix:DR
First Name:LEE
Middle Name:JEFFREY
Last Name:SUCKNO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:170 E MAIN ST
Mailing Address - Street 2:STE 202
Mailing Address - City:ROCKAWAY
Mailing Address - State:NJ
Mailing Address - Zip Code:07866-3530
Mailing Address - Country:US
Mailing Address - Phone:973-627-8915
Mailing Address - Fax:
Practice Address - Street 1:170 E MAIN ST
Practice Address - Street 2:STE 202
Practice Address - City:ROCKAWAY
Practice Address - State:NJ
Practice Address - Zip Code:07866-3530
Practice Address - Country:US
Practice Address - Phone:973-627-8915
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA044353002084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
SU450679Medicare ID - Type Unspecified
C55112Medicare UPIN