Healthcare Provider Details

I. General information

NPI: 1194766824
Provider Name (Legal Business Name): JERRY HUO M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/10/2006
Last Update Date: 12/12/2023
Certification Date: 12/12/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

38-08 UNION STREET, SUITE 3D NY OTOLARYNGOLOGY PLLC
FLUSHING NY
11354
US

IV. Provider business mailing address

38-08 UNION STREET, SUITE 3D NY OTOLARYNGOLOGY PLLC
FLUSHING NY
11354
US

V. Phone/Fax

Practice location:
  • Phone: 718-670-0006
  • Fax: 718-701-5883
Mailing address:
  • Phone: 718-670-0006
  • Fax: 718-701-5883

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License NumberNY192242
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number192242
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: