Provider Demographics
NPI:1316560105
Name:SU, BAW
Entity Type:Individual
Prefix:
First Name:BAW
Middle Name:
Last Name:SU
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:341 OLIVER ST
Mailing Address - Street 2:
Mailing Address - City:N TONAWANDA
Mailing Address - State:NY
Mailing Address - Zip Code:14120-7227
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:341 OLIVER ST
Practice Address - Street 2:
Practice Address - City:N TONAWANDA
Practice Address - State:NY
Practice Address - Zip Code:14120-7227
Practice Address - Country:US
Practice Address - Phone:716-628-6370
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-27
Last Update Date:2020-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider