MEDICARE: DR. DANIEL Y SUH D.M.D

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	1223G0001X	General Practice Dentistry	DI 20464	NJ

General Provider Information

NPI Number	:	1528159878
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DANIEL Y SUH D.M.D

Provider Business Mailing Address
First Line	:	725 RIVER RD
Second Line	:	53
City	:	EDGEWATER
State	:	NJ
Zip	:	07020-1171
Country	:	US
Telephone Number	:	201-943-4000
Fax Number	:	201-943-9714

Provider Business Practice Location Address
First Line	:	725 RIVER RD STE 53
Second Line	:
City	:	EDGEWATER
State	:	NJ
Zip	:	07020-1149
Country	:	US
Telephone Number	:	201-943-4000
Fax Number	:	201-943-9714

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

Provider Enumeration Date	:	09/28/2006
Last Update Date	:	10/05/2012

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