Healthcare Provider Details

I. General information

NPI: 1548793185
Provider Name (Legal Business Name): HUAI MING PHEN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/11/2017
Last Update Date: 09/05/2023
Certification Date: 09/05/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4141 CARPENTER AVE FL 4
BRONX NY
10466-2600
US

IV. Provider business mailing address

4141 CARPENTER AVE FL 4
BRONX NY
10466-2600
US

V. Phone/Fax

Practice location:
  • Phone: 718-920-2060
  • Fax:
Mailing address:
  • Phone: 718-920-2060
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number315091
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code207XX0801X
TaxonomyOrthopaedic Trauma Physician
License Number315091
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: