Healthcare Provider Details

I. General information

NPI: 1003802547
Provider Name (Legal Business Name): GEORGE JUANG MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/20/2005
Last Update Date: 06/16/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13630 MAPLE AVE STE 1G
FLUSHING NY
11355-3869
US

IV. Provider business mailing address

13630 MAPLE AVE STE 1G
FLUSHING NY
11355-3869
US

V. Phone/Fax

Practice location:
  • Phone: 718-300-3368
  • Fax: 718-888-7906
Mailing address:
  • Phone: 718-300-3368
  • Fax: 718-888-7906

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number206004-1
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number206004
License Number StateNY
# 3
Primary TaxonomyY
Taxonomy Code207RC0001X
TaxonomyClinical Cardiac Electrophysiology Physician
License Number206004
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: