Healthcare Provider Details

I. General information

NPI: 1558787747
Provider Name (Legal Business Name): HEUNG NOH M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/11/2014
Last Update Date: 02/26/2025
Certification Date: 02/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

OPC 371 BOX 39
APO AP
96271
US

IV. Provider business mailing address

OPC 371 BOX 39
APO AP
96271
US

V. Phone/Fax

Practice location:
  • Phone: 315-737-1870
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2083X0100X
TaxonomyOccupational Medicine Physician
License Number28673
License Number StateNE
# 2
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number28673
License Number StateNE
# 3
Primary TaxonomyY
Taxonomy Code2083A0100X
TaxonomyAerospace Medicine Physician
License Number28673
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: