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General NPI Number Information
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NPI Number | 1043844905
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Entity Type | Organization
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Legal Business Name | SU SALUD MEDICAL PC
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Dates
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Enumeration Date | 02/28/2020
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Last Update Date | 12/03/2025
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Provider Practice Location Address
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Address Line | 1922 MOTT AVE
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City | FAR ROCKAWAY
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State | NY
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Zip | 11691-4102
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Country | US
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Telephone | 718-868-8282
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Fax | 718-471-2865
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Provider Business Mailing Address
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Address Line | 12415 116TH AVE APT 1
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City | SOUTH OZONE PARK
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State | NY
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Zip | 11420-2522
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Country | US
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Telephone | 718-868-8282
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Fax | 718-471-2865
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Authorized Official
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Title or Position | FNP
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Name | MS. ANNETA C RAMCHARRAN
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Credential |
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Telephone | 718-233-9122
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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