SHIDONG SU, MD,PC (NPI# 1467542530) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1467542530 |
| Entity Type | Organization |
| Organization Name | SHIDONG SU, MD,PC |
| Practice Address |
13621 Roosevelt Ave Suite 305 Flushing NY 11354-5507 |
| Practice Telephone | 7188881803 |
| Practice Fax Number | 7188880957 |
| Mailing Telephone | 7188881803 |
| Mailing Fax Number | 7188880957 |
| Enumeration Date | 2006-10-12 |
| Last Update Date | 2020-08-22 |
| Authorized Official Name | SHIDONG SU (DIRECTOR) |
| Authorized Official Telephone | 7188881803 |
| Authorized Official Credential | M.D. |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 2084N0400X |
Psychiatry & Neurology Specialization: Neurology |
215043 | NY | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| NY | GHI-MEDICARE | 05353 | 01 |
| NY | 02159286 | 05 |
| Street Address |
13621 ROOSEVELT AVE SUITE 305 |
| City | FLUSHING |
| State | NY |
| Zip Code | 11354-5507 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1073061164 | Chang Bi Zou | Physician Assistant | 13621 Roosevelt Ave, Ste 409, Flushing, NY 11354-5655 | 2016-09-17 |
| 1568889475 | Cao & Chen Medical LLP | Internal Medicine | 13621 Roosevelt Ave, Suite 205, Flushing, NY 11354-5655 | 2014-03-28 |
| 1952614661 | Sanjeev Agarwal Md PC | Specialist | 13621 Roosevelt Ave, Ste 409, Flushing, NY 11354-5507 | 2010-07-22 |
| 1467775916 | Cynthia Stich Pt P.C. | Physical Therapist | 13621 Roosevelt Ave, Ste 409, Flushing, NY 11354-5507 | 2010-03-11 |
| 1679896740 | Cynthia Lofgren Stich | Physical Therapist | 13621 Roosevelt Ave, Ste 409, Flushing, NY 11354-5507 | 2010-03-03 |
| 1538490941 | Tammy Huang | Acupuncturist | 13621 Roosevelt Ave, Ste 409, Flushing, NY 11354-5507 | 2010-01-25 |
| 1639404874 | Deepmala Vasdewani | Physical Therapist | 13621 Roosevelt Ave, Suite-409, Flushing, NY 11354-5507 | 2009-10-06 |
| 1295894624 | Cao & Chen LLP | Internal Medicine | 13621 Roosevelt Ave, Suite 205, Flushing, NY 11354-5507 | 2006-12-08 |
| 1801986500 | Yuping Chen | Internal Medicine | 13621 Roosevelt Ave, Suite 205, Flushing, NY 11354-5507 | 2006-10-13 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1699388157 | Laeana Rodriguez | Speech-Language Pathologist | 30-04 146th St, Flushing, NY 11354 | 2020-08-25 |
| 1508402413 | United Community Anesthesia Care Pllc | Anesthesiology | 3636 Maint St, 1s, Flushing, NY 11354 | 2019-11-26 |
| 1922658087 | Xiaoyan Fei | Social Worker | Charles B. Wang Community Health Center 136-26 37th Ave, Flushing, NY 11354 | 2019-09-19 |
| 1235797655 | Life Improvement Homecare, Inc. | Durable Medical Equipment & Medical Supplies | 38-08 Union Street, Suite 2j, Flushing, NY 11354 | 2019-05-31 |
| 1497214985 | Justin Young Lee | Registered Nurse | 143-23 38th Ave, Apt 2c, Flushing, NY 11354 | 2019-03-14 |
| 1669930962 | Jacqueline Nicole Liu | Student in an Organized Health Care Education/Training Program | 29-30 138th Street, Apartment 3f, Flushing, NY 11354 | 2019-03-05 |
| 1275003378 | Janet Poon | Pharmacist | 35-19 Leavitt St., #51, Flushing, NY 11354 | 2018-11-30 |
| 1659856490 | Xiaohui Wang Medical Pllc | Obstetrics & Gynecology | 135 16 Roosevelt Avenue, 3rd Floor, Flushing, NY 11354 | 2018-09-27 |
| 1063990687 | Harmony Care Physical Therapy PC | Clinic/Center | 35-05 Farrington Street, Ste A, Flushing, NY 11354 | 2018-08-06 |
| 1356827604 | Theresa S Cheung | Nurse Practitioner | 39-07 Prince St, Ste 3h, Flushing, NY 11354 | 2018-07-18 |
| Find all providers in zip 11354 | ||||
| Taxonomy Code | 2084N0400X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Psychiatry & Neurology |
| Specialization | Neurology |
| A Neurologist specializes in the diagnosis and treatment of diseases or impaired function of the brain, spinal cord, peripheral nerves, muscles, autonomic nervous system, and blood vessels that relate to these structures. |
| Notes: Source: The American Board of Psychiatry and Neurology, Inc. www.abpn.com [1/1/2007: new definition] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1437593118 | Jin Zhou | Psychiatry & Neurology | 4160 Main St Ste 202, Flushing, NY 11355-3899 | 2013-04-24 |
| 1558457200 | Shidong Su | Psychiatry & Neurology | 136 21 Roosevelt Avenue, Suite 305, Flushing, NY 11354 | 2006-10-04 |
| 1770568974 | Jeffrey Charles Appelbaum | Psychiatry & Neurology | 5907 175th Pl, Flushing, NY 11365-1551 | 2005-12-09 |
| 1821073032 | Wael Kamel | Psychiatry & Neurology | 5907 175th Place, Flushing, NY 11365-1551 | 2005-12-09 |
| 1245701200 | Jin Zhou Neurology, P.C. | Psychiatry & Neurology | 4160 Main St Ste 202, Flushing, NY 11355-3899 | 2018-12-16 |
| 1659861169 | Weiyi Gao Medical Pllc | Psychiatry & Neurology | 13668 Roosevelt Ave Ste 4c, Flushing, NY 11354-5510 | 2018-05-10 |
| 1003323049 | Rvc Medical Consultation PC | Psychiatry & Neurology | 14227 Franklin Ave, Flushing, NY 11355-2629 | 2017-12-29 |
| 1710253737 | Baxter Ballantine Allen | Psychiatry & Neurology | 5645 Main St, Flushing, NY 11355-5045 | 2012-03-23 |
| 1154563526 | Neuro Health PC | Psychiatry & Neurology | 13620 38th Ave, #5a, Flushing, NY 11354-4233 | 2009-04-01 |
| 1063676260 | Jade Yun Hon | Psychiatry & Neurology | 14105 Northern Blvd, 1g, Flushing, NY 11354-4247 | 2008-07-16 |
| Find all providers in FLUSHING | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.