Healthcare Provider Details

I. General information

NPI: 1720085707
Provider Name (Legal Business Name): MATTHEW YONGWON SUH MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/05/2005
Last Update Date: 04/06/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

222 HIGH ST #206
NEWTON NJ
07860-9604
US

IV. Provider business mailing address

888 MAIN ST #140
NEW YORK NY
10044-0213
US

V. Phone/Fax

Practice location:
  • Phone: 646-397-4068
  • Fax: 646-351-0893
Mailing address:
  • Phone: 646-397-4068
  • Fax: 646-351-0893

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code204F00000X
TaxonomyTransplant Surgery Physician
License Number256820
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number224199
License Number StateMA
# 3
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number25MA09125900
License Number StateNJ
# 4
Primary TaxonomyN
Taxonomy Code2086X0206X
TaxonomySurgical Oncology Physician
License Number256820
License Number StateNY
# 5
Primary TaxonomyY
Taxonomy Code2086X0206X
TaxonomySurgical Oncology Physician
License Number25MA09125900
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: