MEDICARE: AMY SU MD PHD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RN0300X	Nephrology Physician	234906	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1255315776
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMY SU MD PHD

Provider Business Mailing Address
First Line	:	3916 PRINCE ST STE 155
Second Line	:
City	:	FLUSHING
State	:	NY
Zip	:	11354-5367
Country	:	US
Telephone Number	:	917-563-5789
Fax Number	:	917-563-5737

Provider Business Practice Location Address
First Line	:	3916 PRINCE ST STE 155
Second Line	:
City	:	FLUSHING
State	:	NY
Zip	:	11354-5367
Country	:	US
Telephone Number	:	917-563-5789
Fax Number	:	917-563-5737

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/30/2005
Last Update Date	:	07/02/2019

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Directions to “ AMY SU MD PHD” Practice Location

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