Healthcare Provider Details

I. General information

NPI: 1083430441
Provider Name (Legal Business Name): LESLIE HUANG
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/02/2024
Last Update Date: 10/08/2026
Certification Date: 10/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6248 83RD ST
MIDDLE VILLAGE NY
11379-1906
US

IV. Provider business mailing address

6248 83RD ST
MIDDLE VILLAGE NY
11379-1906
US

V. Phone/Fax

Practice location:
  • Phone: 718-812-9515
  • Fax:
Mailing address:
  • Phone: 718-812-9515
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number036018
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: