Healthcare Provider Details

I. General information

NPI: 1346012713
Provider Name (Legal Business Name): DR. ZHUOFAN HUANG
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/27/2023
Last Update Date: 10/29/2023
Certification Date: 10/29/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

614 COLUMBIA TPKE
EAST GREENBUSH NY
12061-1610
US

IV. Provider business mailing address

5912 146TH ST FL 1
FLUSHING NY
11355-5328
US

V. Phone/Fax

Practice location:
  • Phone: 917-943-8852
  • Fax:
Mailing address:
  • Phone: 917-943-8852
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number071044
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: