Healthcare Provider Details

I. General information

NPI: 1720035108
Provider Name (Legal Business Name): LOLI HUANG M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/30/2006
Last Update Date: 06/20/2023
Certification Date: 06/20/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17415 HORACE HARDING EXPY
FRESH MEADOWS NY
11365
US

IV. Provider business mailing address

17415 HORACE HARDING EXPY
FRESH MEADOWS NY
11365-1527
US

V. Phone/Fax

Practice location:
  • Phone: 718-762-3111
  • Fax:
Mailing address:
  • Phone: 718-762-3111
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License Number232966
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: