Healthcare Provider Details

I. General information

NPI: 1487381711
Provider Name (Legal Business Name): RICKY HUANG
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/05/2022
Last Update Date: 08/05/2022
Certification Date: 08/04/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4035 21ST ST
LONG ISLAND CITY NY
11101-6140
US

IV. Provider business mailing address

8281 159TH ST
JAMAICA NY
11432-1105
US

V. Phone/Fax

Practice location:
  • Phone: 347-242-2981
  • Fax:
Mailing address:
  • Phone: 646-229-5483
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number069170
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: