Provider Demographics
NPI:1780099044
Name:SUH, MICHELLE (DPM)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:
Last Name:SUH
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 RTE 17
Mailing Address - Street 2:
Mailing Address - City:RIDGEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07450-2010
Mailing Address - Country:US
Mailing Address - Phone:201-445-2288
Mailing Address - Fax:201-445-2288
Practice Address - Street 1:400 RTE 17
Practice Address - Street 2:
Practice Address - City:RIDGEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07450-2010
Practice Address - Country:US
Practice Address - Phone:201-445-2288
Practice Address - Fax:201-445-2288
Is Sole Proprietor?:No
Enumeration Date:2014-06-25
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MD00337400213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery