Healthcare Provider Details

I. General information

NPI: 1245220490
Provider Name (Legal Business Name): THIERRY JOHN HUFNAGEL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/27/2005
Last Update Date: 10/07/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

450 ENDO BLVD
GARDEN CITY NY
11530-6723
US

IV. Provider business mailing address

148 BRITE AVE
SCARSDALE NY
10583-1427
US

V. Phone/Fax

Practice location:
  • Phone: 516-832-8000
  • Fax: 516-832-8379
Mailing address:
  • Phone: 914-725-3536
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number1933291
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: