Healthcare Provider Details

I. General information

NPI: 1265197941
Provider Name (Legal Business Name): JIA WEI HUANG
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/08/2021
Last Update Date: 11/08/2021
Certification Date: 10/25/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

315 CAMPBELL BLVD APT 203
GETZVILLE NY
14068-1074
US

IV. Provider business mailing address

315 CAMPBELL BLVD APT 203
GETZVILLE NY
14068-1074
US

V. Phone/Fax

Practice location:
  • Phone: 646-330-2328
  • Fax:
Mailing address:
  • Phone: 646-330-2328
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number068458
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: