Healthcare Provider Details

I. General information

NPI: 1942299516
Provider Name (Legal Business Name): HUAIBAO SHENG MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/17/2005
Last Update Date: 09/24/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

246 INDUSTRIAL WAY W SUITE 2
EATONTOWN NJ
07724-4240
US

IV. Provider business mailing address

11025 RCA CENTER DR STE 300
PALM BEACH GARDENS FL
33410-4269
US

V. Phone/Fax

Practice location:
  • Phone: 732-389-5200
  • Fax: 732-389-5299
Mailing address:
  • Phone: 561-383-3820
  • Fax: 855-369-2450

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License Number25MA07695000
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License Number2270058
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: