Su, Shidong
Su, Shidong is an sole proprietor health care provider with primary practice located at 136 21 Roosevelt Avenue Suite 305, Flushing NY 11354. He recently has only one registered license in Allopathic & Osteopathic Physicians / Neurology, which is considered as his primary health care specialty. Su, Shidong can be contacted via phone (718) 888-1803.Contact Information
Primary practice address
136 21 Roosevelt Avenue Suite 305
Flushing NY 11354
Phone: (718) 888-1803
Fax: (718) 888-0957
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Neurology | 2084N0400X | 215043 | New York |
Profile Details
| NPI number | 1558457200 |
|---|---|
| LBN Legal business name | Su, Shidong |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | Yes |
| Enumeration date | Oct 4th, 2006 |
| Last updated | Jul 8th, 2007 - about 18 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1558457200 | NPPES |
| New York | MEDICAID | 02159286 | |
| New York | Other | 05353 |
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