Provider Demographics
NPI:1104870427
Name:SU, MICHAEL Y (MD)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:Y
Last Name:SU
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:620 CRANBURY RD
Mailing Address - Street 2:SUITE 205
Mailing Address - City:EAST BRUNSWICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08816-4098
Mailing Address - Country:US
Mailing Address - Phone:732-708-3937
Mailing Address - Fax:609-228-5120
Practice Address - Street 1:620 CRANBURY RD
Practice Address - Street 2:SUITE 205
Practice Address - City:EAST BRUNSWICK
Practice Address - State:NJ
Practice Address - Zip Code:08816-4098
Practice Address - Country:US
Practice Address - Phone:732-708-3937
Practice Address - Fax:609-228-5120
Is Sole Proprietor?:No
Enumeration Date:2006-05-20
Last Update Date:2015-01-04
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Provider Licenses
StateLicense IDTaxonomies
NJ25MA08228100174400000X, 207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJI52432Medicare UPIN