Organization
SHIDONG SU, MD,PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SHIDONG SU M.D. (DIRECTOR)
(718) 888-1803
Entity
Organization
Contact information
Practice address
13621 ROOSEVELT AVE, SUITE 305, FLUSHING, NY 11354-5507
(718) 888-1803
(718) 888-0957
Mailing address
13621 ROOSEVELT AVE, SUITE 305, FLUSHING, NY 11354-5507
(718) 888-1803
(718) 888-0957
Taxonomy
Speciality
Code
Description
License number
State
2084N0400X
Neurology Physician
Primary
215043
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
02159286
—
NY
01
—
05353
GHI-MEDICARE
NY
Enumeration date
10/12/2006
Last updated
08/22/2020
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