1720085707 NPI number — DR. MATTHEW YONGWON SUH MD

Table of content: DR. MATTHEW YONGWON SUH MD (NPI 1720085707)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1720085707 NPI number — DR. MATTHEW YONGWON SUH MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SUH
Provider First Name:
MATTHEW
Provider Middle Name:
YONGWON
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1720085707
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/06/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
888 MAIN ST
Provider Second Line Business Mailing Address:
#140
Provider Business Mailing Address City Name:
NEW YORK
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
10044-0213
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
646-397-4068
Provider Business Mailing Address Fax Number:
646-351-0893

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
222 HIGH ST
Provider Second Line Business Practice Location Address:
#206
Provider Business Practice Location Address City Name:
NEWTON
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07860-9604
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
646-397-4068
Provider Business Practice Location Address Fax Number:
646-351-0893
Provider Enumeration Date:
07/05/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 208600000X , with the licence number:  224199 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 204F00000X , with the licence number: 256820 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2086X0206X , with the licence number: 256820 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2086X0206X , with the licence number: 25MA09125900 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 208600000X , with the licence number: 25MA09125900 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)





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