Healthcare Provider Details

I. General information

NPI: 1619951191
Provider Name (Legal Business Name): WEN-HAUR HUANG M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 11/30/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7492 RT.54
BATH NY
14810-0431
US

IV. Provider business mailing address

310 BURTON ST
BATH NY
14810-9207
US

V. Phone/Fax

Practice location:
  • Phone: 607-776-6188
  • Fax:
Mailing address:
  • Phone: 607-776-9824
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number121538
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: