Healthcare Provider Details

I. General information

NPI: 1316087067
Provider Name (Legal Business Name): SU-I DANIEL HUANG M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/08/2007
Last Update Date: 06/02/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

935 NORTHERN BOULEVARD SUITE 103
GREAT NECK NY
11021
US

IV. Provider business mailing address

935 NORTHERN BLVD SUITE 103
GREAT NECK NY
11021-5316
US

V. Phone/Fax

Practice location:
  • Phone: 516-482-1400
  • Fax: 516-466-6575
Mailing address:
  • Phone: 516-482-1400
  • Fax: 516-466-6575

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License Number228033
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: