Healthcare Provider Details

I. General information

NPI: 1205857596
Provider Name (Legal Business Name): POK-SHINE HUANG MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/21/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18005 HILLSIDE AVE
JAMAICA NY
11432-4727
US

IV. Provider business mailing address

1000 ZECKENDORF BLVD
GARDEN CITY NY
11530-2133
US

V. Phone/Fax

Practice location:
  • Phone: 718-262-6300
  • Fax: 718-262-7045
Mailing address:
  • Phone: 516-542-6880
  • Fax: 516-542-5556

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number117525
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: