| Long Su, Dds, Pc | |
|
254 Canal St Rm 4008 New York NY 10013-3501 | |
| (212) 966-3649 | |
| Not Available |
| Full Name | Long Su, Dds, Pc |
|---|---|
| Speciality | Dentist |
| Location | 254 Canal St Rm 4008, New York, New York |
| Authorized Official Name and Position | Long Su (PRESIDENT) |
| Authorized Official Contact | 2129663649 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Long Su, Dds, Pc 254 Canal St Rm 4008 New York NY 10013-3501 Ph: (212) 966-3649 | Long Su, Dds, Pc 254 Canal St Rm 4008 New York NY 10013-3501 Ph: (212) 966-3649 |
| NPI Number | 1750765533 |
|---|---|
| Provider Enumeration Date | 07/12/2015 |
| Last Update Date | 07/12/2015 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1750765533 | NPI | - | NPPES |
| 01711935 | Medicaid | NY |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 122300000X | Dentist | 046375 (New York) | Primary |
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