Provider Demographics
NPI:1306907373
Name:SUH, CHANG SAM (MD)
Entity type:Individual
Prefix:DR
First Name:CHANG
Middle Name:SAM
Last Name:SUH
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:111 BEAVER DAM RD
Mailing Address - Street 2:
Mailing Address - City:BROOKHAVEN
Mailing Address - State:NY
Mailing Address - Zip Code:11719-9715
Mailing Address - Country:US
Mailing Address - Phone:631-306-5750
Mailing Address - Fax:631-306-5884
Practice Address - Street 1:998 CROOKED HILL RD BLDG 5
Practice Address - Street 2:
Practice Address - City:BRENTWOOD
Practice Address - State:NY
Practice Address - Zip Code:11717-1043
Practice Address - Country:US
Practice Address - Phone:631-306-5750
Practice Address - Fax:631-306-5884
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-13
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY1565952084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01907157Medicaid
NY67M481Medicare ID - Type Unspecified
NY01907157Medicaid