Provider Demographics
NPI:1982635298
Name:SU, JENNY CHING-YA (MD)
Entity Type:Individual
Prefix:DR
First Name:JENNY
Middle Name:CHING-YA
Last Name:SU
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:227 MADISON ST
Mailing Address - Street 2:ROOM 384
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10002-7537
Mailing Address - Country:US
Mailing Address - Phone:212-238-7614
Mailing Address - Fax:212-238-7009
Practice Address - Street 1:227 MADISON ST
Practice Address - Street 2:ROOM 384
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10002-7537
Practice Address - Country:US
Practice Address - Phone:212-238-7614
Practice Address - Fax:212-238-7009
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-05
Last Update Date:2009-03-13
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY2523442084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYI33375Medicare UPIN
NY521BH1Medicare ID - Type Unspecified