Individual
SHIDONG SU
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
136 21 ROOSEVELT AVENUE, SUITE 305, FLUSHING, NY 11354
(718) 888-1803
(718) 888-0957
Mailing address
136 21 ROOSEVELT AVENUE, SUITE 305, FLUSHING, NY 11354
(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
10/04/2006
Last updated
07/08/2007
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