Healthcare Provider Details

I. General information

NPI: 1093159097
Provider Name (Legal Business Name): MAOCHENG HUANG
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/20/2013
Last Update Date: 04/20/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7347 190TH ST
FRESH MEADOWS NY
11366-1853
US

IV. Provider business mailing address

7347 190TH ST
FRESH MEADOWS NY
11366-1853
US

V. Phone/Fax

Practice location:
  • Phone: 646-330-0733
  • Fax:
Mailing address:
  • Phone: 646-330-0733
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number057862
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number52504
License Number StateTX
# 3
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number28RI03550300
License Number StateNJ
# 4
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPCT.0012507
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: