Individual
DIANA T SU
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
2500 NESCONSET HWY, BLDG 12C, STONY BROOK, NY 11790
(631) 807-0128
(631) 246-5817
Mailing address
2500 NESCONSET HWY, BLDG 12C, STONY BROOK, NY 11790
(631) 807-0128
(631) 246-5817
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
MD113818
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
G003052486
—
NY
Enumeration date
05/27/2008
Last updated
05/27/2008
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