Healthcare Provider Details

I. General information

NPI: 1447887294
Provider Name (Legal Business Name): ALISEN HUANG MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/23/2020
Last Update Date: 04/30/2024
Certification Date: 04/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

450 CLARKSON AVE # 46
BROOKLYN NY
11203-2012
US

IV. Provider business mailing address

422 PROSPECT AVE APT 1
BROOKLYN NY
11215-7127
US

V. Phone/Fax

Practice location:
  • Phone: 182-701-2297
  • Fax: 646-793-9815
Mailing address:
  • Phone:
  • Fax: 646-793-9815

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number321077
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: