Provider Demographics
NPI:1063050896
Name:LEDO SUAREZ, LUIS
Entity type:Individual
Prefix:
First Name:LUIS
Middle Name:
Last Name:LEDO SUAREZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1775 WINDSOR RD APT 438
Mailing Address - Street 2:
Mailing Address - City:TEANECK
Mailing Address - State:NJ
Mailing Address - Zip Code:07666-3018
Mailing Address - Country:US
Mailing Address - Phone:787-934-5721
Mailing Address - Fax:
Practice Address - Street 1:153 BERGEN BLVD
Practice Address - Street 2:
Practice Address - City:FAIRVIEW
Practice Address - State:NJ
Practice Address - Zip Code:07022-1941
Practice Address - Country:US
Practice Address - Phone:201-366-0805
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-12-11
Last Update Date:2019-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00765400111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor