Individual provider Active NPI

Rachael Su, PA-C

  • Physician Assistant
  • Florham Park, NJ
National Provider Identifier
1649064692
Registry record updated Jul 13, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
033929 Issued in NY
Practice address
200 Park Ave
Florham Park, NJ 07932-1026
Phone
(973) 443-8401
NPI assigned
Apr 7, 2025
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 13, 2026

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 033929 NY Primary

Addresses

Primary practice location

200 Park Ave
Florham Park, NJ 07932-1026

Mailing address

200 Park Ave
Florham Park, NJ 07932-1026

Electronic endpoints 1

TypeEndpointUseAffiliation
CONNECT URL https://esmd.officeally.io:8291/Gateway/DocumentSubmission/2_0/NhinService/XDRRequest_Service Other Bluemark LLC / Office Ally

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20251104003760 NY Practitioner - Physician Assistant 0547750010 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2025
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
North Shore-Lij Medical PCGroup PAC ID 3375701568, 6,374 clinicians

Practice addresses (Care Compare)

10201 66TH Rd
Forest Hills, NY 11375-2029
Phone (718) 830-4000

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
033929NYMDPediatric Physical Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
North Shore-Lij Medical PC CurrentSince Aug 25, 2025 Accepting new patients
North Shore - Lij Medical PC CurrentSince Aug 25, 2025 Accepting new patients

Locations

10201 66th Rd
Forest Hills, NY 11375
Phone (718) 830-4091

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1743984000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1783900800000",
    "number": "1649064692",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "200 PARK AVE",
            "city": "FLORHAM PARK",
            "state": "NJ",
            "postal_code": "079321026"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "200 PARK AVE",
            "city": "FLORHAM PARK",
            "state": "NJ",
            "postal_code": "079321026",
            "telephone_number": "973-443-8401"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SU",
        "first_name": "RACHAEL",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2025-04-07",
        "last_updated": "2026-07-13",
        "certification_date": "2026-07-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NY",
            "license": "033929",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "https://esmd.officeally.io:8291/Gateway/DocumentSubmission/2_0/NhinService/XDRRequest_Service",
            "affiliation": "Y",
            "endpointDescription": "2.16.840.1.113883.3.2019.3",
            "affiliationName": "Bluemark LLC / Office Ally",
            "use": "OTHER",
            "useDescription": "Other",
            "useOtherDescription": "CMS esMD eMDR",
            "address_1": "1300 SE Cardinal Ct Ste 190",
            "city": "Vancouver",
            "state": "WA",
            "country_code": "US",
            "postal_code": "986839683",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Florham Park, NJ

Sources for this page

Verify at the official NPI Registry.