Provider Demographics
NPI:1538158746
Name:JAMES Y. SU, D.D.S., P.C.
Entity type:Organization
Organization Name:JAMES Y. SU, D.D.S., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:Y
Authorized Official - Last Name:SU
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:212-928-4800
Mailing Address - Street 1:601 W 181ST ST
Mailing Address - Street 2:SUITE 24
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10033-4914
Mailing Address - Country:US
Mailing Address - Phone:212-928-4800
Mailing Address - Fax:212-928-3436
Practice Address - Street 1:601 W 181ST ST
Practice Address - Street 2:SUITE 24
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10033-4914
Practice Address - Country:US
Practice Address - Phone:212-928-4800
Practice Address - Fax:212-928-3436
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-19
Last Update Date:2008-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY041389261QS0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS0112XAmbulatory Health Care FacilitiesClinic/CenterOral and Maxillofacial Surgery