MEDICARE: JIA HUI 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	363LA2200X	Adult Health Nurse Practitioner	F309326-01	NY

General Provider Information

NPI Number	:	1881232478
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JIA HUI SU

Provider Business Mailing Address
First Line	:	7206 BAY PKWY
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11204-6026
Country	:	US
Telephone Number	:	917-346-8658
Fax Number	:

Provider Business Practice Location Address
First Line	:	7206 BAY PKWY
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11204-6026
Country	:	US
Telephone Number	:	718-489-9118
Fax Number	:	718-232-1904

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

Provider Enumeration Date	:	12/15/2019
Last Update Date	:	04/20/2023

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Directions to “ JIA HUI SU ” Practice Location

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