Provider Demographics
NPI:1336112903
Name:SU, CHEN-PANG (MD)
Entity Type:Individual
Prefix:
First Name:CHEN-PANG
Middle Name:
Last Name:SU
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:733 N BEERS ST
Mailing Address - Street 2:SUITE L2
Mailing Address - City:HOLMDEL
Mailing Address - State:NJ
Mailing Address - Zip Code:07733
Mailing Address - Country:US
Mailing Address - Phone:732-264-4020
Mailing Address - Fax:732-264-1292
Practice Address - Street 1:733 N BEERS ST
Practice Address - Street 2:SUITE L2
Practice Address - City:HOLMDEL
Practice Address - State:NJ
Practice Address - Zip Code:07733
Practice Address - Country:US
Practice Address - Phone:732-264-4020
Practice Address - Fax:732-264-1292
Is Sole Proprietor?:No
Enumeration Date:2006-02-13
Last Update Date:2008-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA02623600207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ426914Medicare ID - Type Unspecified
B80088Medicare UPIN