Healthcare Provider Details

I. General information

NPI: 1649540097
Provider Name (Legal Business Name): HUH EAR NOSE & THROAT, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/03/2012
Last Update Date: 01/03/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

125 SAINT NICHOLAS AVE
BROOKLYN NY
11237-4059
US

IV. Provider business mailing address

2 LAKEVIEW DR
GREAT NECK NY
11020-1618
US

V. Phone/Fax

Practice location:
  • Phone: 718-756-9025
  • Fax: 718-821-6444
Mailing address:
  • Phone: 516-829-1801
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number2014331
License Number StateNY

VIII. Authorized Official

Name: MRS. SUSAN HUH
Title or Position: OFFICE MANAGER
Credential:
Phone: 516-829-1801