Healthcare Provider Details

I. General information

NPI: 1639146475
Provider Name (Legal Business Name): TONY T HUANG MD
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 03/01/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

158 LINWOOD PLZ
FORT LEE NJ
07024-3761
US

IV. Provider business mailing address

158 LINWOOD PLZ
FORT LEE NJ
07024-3704
US

V. Phone/Fax

Practice location:
  • Phone: 201-585-8686
  • Fax: 201-585-0606
Mailing address:
  • Phone: 201-585-8686
  • Fax: 201-585-0606

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number25MA05222600
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: