Provider Demographics
NPI:1902898588
Name:GJONAJ, SUZETTE (MD)
Entity Type:Individual
Prefix:
First Name:SUZETTE
Middle Name:
Last Name:GJONAJ
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 1:19 BRADHURST AVE
Mailing Address - Street 2:STE 1400
Mailing Address - City:HAWTHORNE
Mailing Address - State:NY
Mailing Address - Zip Code:10532-2140
Mailing Address - Country:US
Mailing Address - Phone:914-493-7585
Mailing Address - Fax:914-594-4336
Practice Address - Street 1:19 BRADHURST AVE
Practice Address - Street 2:STE 1400
Practice Address - City:HAWTHORNE
Practice Address - State:NY
Practice Address - Zip Code:10532-2140
Practice Address - Country:US
Practice Address - Phone:914-493-7585
Practice Address - Fax:914-594-4336
Is Sole Proprietor?:No
Enumeration Date:2005-08-18
Last Update Date:2015-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1951092080P0214X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0214XAllopathic & Osteopathic PhysiciansPediatricsPediatric Pulmonology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01629423Medicaid
NY52613EA201Medicare PIN
NY01629423Medicaid