Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 2084N0400X | Neurologist | 243583 | NY |
Y | 2084N0402X | Child Neurologist | 243583 | NY |
NPI | 1003076886 |
---|---|
Provider Name | Dr. Jungman Michael Suh |
First Address | Flushing, NY 11358-2824 |
Second Address | Flushing, NY 11358-2824 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 14/06/2008 |
Last Update Date | 06/12/2021 |