Healthcare Provider Details

I. General information

NPI: 1124063466
Provider Name (Legal Business Name): TENG LUNG HSU M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/19/2006
Last Update Date: 11/24/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

250 PATCHOGUE YAPHANK RD SUITE 5
EAST PATCHOGUE NY
11772-4862
US

IV. Provider business mailing address

250 PATCHOGUE YAPHANK RD SUITE 5
EAST PATCHOGUE NY
11772-4862
US

V. Phone/Fax

Practice location:
  • Phone: 631-654-3330
  • Fax: 631-654-3329
Mailing address:
  • Phone: 631-654-3330
  • Fax: 631-654-3329

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number111312
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: