Active NPI
Jefferson Su
- Physician Assistant
- Elmhurst, NY
National Provider Identifier
1386555456
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- Practice address
- 5119 Goldsmith St
Elmhurst, NY 11373-4240 - Phone
- (917) 502-1196
- NPI assigned
- Sep 16, 2026
- Sex
- Unspecified or another gender identity
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | Primary |
Addresses
Primary practice location
5119 Goldsmith St
Elmhurst, NY 11373-4240
Mailing address
5119 Goldsmith St
Elmhurst, NY 11373-4240
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1789516800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1789516800000",
"number": "1386555456",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5119 GOLDSMITH ST",
"city": "ELMHURST",
"state": "NY",
"postal_code": "113734240"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5119 GOLDSMITH ST",
"city": "ELMHURST",
"state": "NY",
"postal_code": "113734240",
"telephone_number": "917-502-1196"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SU",
"first_name": "JEFFERSON",
"sole_proprietor": "NO",
"sex": "X",
"enumeration_date": "2026-09-16",
"last_updated": "2026-09-16",
"certification_date": "2026-09-16",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Elmhurst, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 16, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.