Provider Demographics
NPI:1255315776
Name:SU, AMY (MD PHD)
Entity Type:Individual
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First Name:AMY
Middle Name:
Last Name:SU
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Gender:F
Credentials:MD PHD
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Mailing Address - Street 1:3916 PRINCE ST STE 155
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11354-5367
Mailing Address - Country:US
Mailing Address - Phone:917-563-5789
Mailing Address - Fax:917-563-5737
Practice Address - Street 1:3916 PRINCE ST STE 155
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11354-5367
Practice Address - Country:US
Practice Address - Phone:917-563-5789
Practice Address - Fax:917-563-5737
Is Sole Proprietor?:No
Enumeration Date:2005-11-30
Last Update Date:2019-07-02
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Provider Licenses
StateLicense IDTaxonomies
NY234906207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02681267Medicaid
I36631Medicare UPIN
NY02681267Medicaid