Healthcare Provider Details

I. General information

NPI: 1316491103
Provider Name (Legal Business Name): JUDY HUANG
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/09/2016
Last Update Date: 08/09/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1630 CONEY ISLAND AVE
BROOKLYN NY
11230-4716
US

IV. Provider business mailing address

1630 CONEY ISLAND AVE
BROOKLYN NY
11230-4716
US

V. Phone/Fax

Practice location:
  • Phone: 718-258-4200
  • Fax:
Mailing address:
  • Phone: 718-258-4200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number061872
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: