Provider Demographics
NPI:1427146042
Name:KOWAL-CONNELLY, SUANNE (MD)
Entity type:Individual
Prefix:DR
First Name:SUANNE
Middle Name:
Last Name:KOWAL-CONNELLY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:55 N OCEAN AVE
Mailing Address - Street 2:
Mailing Address - City:FREEPORT
Mailing Address - State:NY
Mailing Address - Zip Code:11520-3035
Mailing Address - Country:US
Mailing Address - Phone:516-379-1535
Mailing Address - Fax:516-223-4962
Practice Address - Street 1:55 N OCEAN AVE
Practice Address - Street 2:
Practice Address - City:FREEPORT
Practice Address - State:NY
Practice Address - Zip Code:11520-3035
Practice Address - Country:US
Practice Address - Phone:516-379-1535
Practice Address - Fax:516-223-4962
Is Sole Proprietor?:No
Enumeration Date:2006-10-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1669572080A0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYC12136Medicare UPIN