Healthcare Provider Details

I. General information

NPI: 1770474850
Provider Name (Legal Business Name): TIAN HUANG AGPCNP-BC, MSN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/15/2025
Last Update Date: 07/15/2025
Certification Date: 07/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8611 252ND ST
BELLEROSE NY
11426-2409
US

IV. Provider business mailing address

8611 252ND ST
BELLEROSE NY
11426-2409
US

V. Phone/Fax

Practice location:
  • Phone: 646-236-2119
  • Fax:
Mailing address:
  • Phone: 646-236-2119
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number312375
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: