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SHIDONG SU M.D.
NPI 1558457200
Psychiatry & Neurology - Neurology in Flushing, NY

Active since October 04, 2006PECOS Enrolled
136 21 ROOSEVELT AVENUE, SUITE 305, FLUSHING, NY 11354(718) 888-1803(718) 888-0957 Get Directions Write a Review

NPPES record last updated: July 8, 2007. Verified against the NPPES registry weekly; last sync: September 13, 2026.

About Shidong Su M.d. NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

SHIDONG SU M.D. (NPI 1558457200) is an individual neurology provider in Flushing, New York, licensed in New York (215043) and active in the NPI registry since October 2006. He is enrolled in Medicare PECOS.

NPPES Registry Identity

NPI1558457200
Entity TypeIndividualMale
Primary Taxonomy2084N0400X
Provider Legal NameSHIDONG SUCredential: M.D.
Location Address136 21 ROOSEVELT AVENUE, SUITE 305Flushing, NY 11354
Mailing Address136 21 Roosevelt Avenue, Suite 305Flushing, NY 11354 · (718) 888-1803 · Fax (718) 888-0957
Phone(718) 888-1803
Fax(718) 888-0957
Sole ProprietorYes
Enumeration DateOctober 4, 2006
Last NPPES UpdateJuly 8, 2007
✔ NPI 1558457200 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyPsychiatry & Neurology · NeurologyAllopathic & Osteopathic Physicians
Taxonomy Code2084N0400X
License✔ Licensed in NY · 215043
Definition
A Neurologist specializes in the diagnosis and treatment of diseases or impaired function of the brain, spinal cord, peripheral nerves, muscles, autonomic nervous system, and blood vessels that relate to these structures.
136 21 ROOSEVELT AVENUE, Flushing, NY 11354
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Other Identifiers 4

Other05353NY · Ghi-medicare
Medicare ID-Type Unspecified5P4101NY
Medicaid02159286NY
Medicare UPINH41923NY

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Shidong Su M.d. is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment✔ Home Health Agency✔ Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 11354 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.

New Patient
$153.13 typical visit price
range $67.00 – $201.98
Typical copayment $38.28 (range $16.75 – $50.49)
Most-billed visit code 99204
Established Patient
$116.96 typical visit price
range $21.62 – $163.52
Typical copayment $29.24 (range $5.40 – $40.88)
Most-billed visit code 99214
Amounts reflect what Medicare beneficiaries in this ZIP area are typically charged for office visits. Patients with other coverage should check their individual plans.

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Shidong Su's NPI number?

The NPI number for Shidong Su is 1558457200. It was assigned to this individual provider in the NPPES registry on October 4, 2006.

Where is Shidong Su located?

Shidong Su practices at 136 21 Roosevelt Avenue Suite 305, Flushing, NY 11354. The listed phone number is (718) 888-1803.

What is Shidong Su's specialty?

The primary specialty registered for this NPI is Psychiatry & Neurology, specializing in Neurology, with taxonomy code 2084N0400X.

Is Shidong Su enrolled in Medicare?

Yes. Shidong Su is registered in the Medicare PECOS enrollment system.

When was this NPI record last updated?

The NPPES record for Shidong Su was last updated on July 8, 2007. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 19 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.