Healthcare Provider Details

I. General information

NPI: 1730412008
Provider Name (Legal Business Name): ANTHONY H HOANG RPA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/17/2009
Last Update Date: 09/17/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 COMMUNITY DR
MANHASSET NY
11030-3816
US

IV. Provider business mailing address

3 TIMBER RIDGE DR
HUNTINGTON NY
11743-4870
US

V. Phone/Fax

Practice location:
  • Phone: 516-562-0100
  • Fax:
Mailing address:
  • Phone: 949-232-8913
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number013455-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: