Healthcare Provider Details

I. General information

NPI: 1780611087
Provider Name (Legal Business Name): PECK PO-HSIUNG HSU M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/26/2006
Last Update Date: 07/08/2007
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:
Title or Position:
Credential:
Phone: