Healthcare Provider Details

I. General information

NPI: 1447554076
Provider Name (Legal Business Name): HSU INTERNAL MEDICINE PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/21/2010
Last Update Date: 12/21/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

971 HICKSVILLE RD
MASSAPEQUA NY
11758-1252
US

IV. Provider business mailing address

971 HICKSVILLE RD
MASSAPEQUA NY
11758-1252
US

V. Phone/Fax

Practice location:
  • Phone: 516-541-7393
  • Fax: 516-541-5313
Mailing address:
  • Phone: 516-541-7393
  • Fax: 516-541-5313

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number111311
License Number StateNY

VIII. Authorized Official

Name: PECK P. HSU
Title or Position: PRESIDENT
Credential: MD
Phone: 516-541-7393