Healthcare Provider Details

I. General information

NPI: 1396999074
Provider Name (Legal Business Name): JI Y HUANG
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/08/2008
Last Update Date: 11/08/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19 UNION AVE ROOM 201
RUTHERFORD NJ
07070-1200
US

IV. Provider business mailing address

19 UNION AVE ROOM 201
RUTHERFORD NJ
07070-1200
US

V. Phone/Fax

Practice location:
  • Phone: 201-615-1285
  • Fax:
Mailing address:
  • Phone: 201-615-1285
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number26BT00145700
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: