Provider Demographics
NPI:1437141769
Name:SUE, HONG-SUK (MD)
Entity Type:Individual
Prefix:DR
First Name:HONG-SUK
Middle Name:
Last Name:SUE
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 1:14251 BOOTH MEMORIAL AVE
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11355-5343
Mailing Address - Country:US
Mailing Address - Phone:718-458-9055
Mailing Address - Fax:718-458-3258
Practice Address - Street 1:87-12 58TH AVE
Practice Address - Street 2:
Practice Address - City:ELMHURST
Practice Address - State:NY
Practice Address - Zip Code:11373
Practice Address - Country:US
Practice Address - Phone:718-458-9055
Practice Address - Fax:718-458-3258
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY121842174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00298926Medicaid
C08809Medicare UPIN
NY13497Medicare ID - Type Unspecified