Provider Demographics
NPI:1831299361
Name:MA, SHU-SHAN (MD)
Entity Type:Individual
Prefix:DR
First Name:SHU-SHAN
Middle Name:
Last Name:MA
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 1:1700 GRAND CONCOURSE
Mailing Address - Street 2:14J
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10457-7646
Mailing Address - Country:US
Mailing Address - Phone:718-716-0104
Mailing Address - Fax:
Practice Address - Street 1:1650 GRAND CONCOURSE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10457-7606
Practice Address - Country:US
Practice Address - Phone:718-518-5152
Practice Address - Fax:718-716-8242
Is Sole Proprietor?:No
Enumeration Date:2006-09-24
Last Update Date:2010-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY190754207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02061672Medicaid
NYH15694Medicare UPIN
NY11Y932Medicare ID - Type Unspecified