Provider Demographics
NPI:1720085707
Name:SUH, MATTHEW YONGWON (MD)
Entity Type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:YONGWON
Last Name:SUH
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:888 MAIN ST
Mailing Address - Street 2:#140
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10044-0213
Mailing Address - Country:US
Mailing Address - Phone:646-397-4068
Mailing Address - Fax:646-351-0893
Practice Address - Street 1:222 HIGH ST
Practice Address - Street 2:#206
Practice Address - City:NEWTON
Practice Address - State:NJ
Practice Address - Zip Code:07860-9604
Practice Address - Country:US
Practice Address - Phone:646-397-4068
Practice Address - Fax:646-351-0893
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-05
Last Update Date:2015-04-06
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MA224199208600000X
NY256820204F00000X, 2086X0206X
NJ25MA091259002086X0206X, 208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086X0206XAllopathic & Osteopathic PhysiciansSurgerySurgical Oncology
No208600000XAllopathic & Osteopathic PhysiciansSurgery
No204F00000XAllopathic & Osteopathic PhysiciansTransplant Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ244315U77Medicare PIN
NYA400031020Medicare PIN