MEDICARE: LINYA SU

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	171M00000X	Case Manager/Care Coordinator

General Provider Information

NPI Number	:	1366801060
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LINYA SU

Provider Business Mailing Address
First Line	:	108 PARK TER E
Second Line	:	APT. 4F
City	:	NEW YORK
State	:	NY
Zip	:	10034-1423
Country	:	US
Telephone Number	:	646-509-0556
Fax Number	:

Provider Business Practice Location Address
First Line	:	108 PARK TER E
Second Line	:	APT. 4F
City	:	NEW YORK
State	:	NY
Zip	:	10034-1423
Country	:	US
Telephone Number	:	646-509-0556
Fax Number	:

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

Provider Enumeration Date	:	02/23/2016
Last Update Date	:	02/23/2016

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Directions to “ LINYA SU ” Practice Location

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