Healthcare Provider Details

I. General information

NPI: 1023186194
Provider Name (Legal Business Name): MARY YAJEN HUANG DNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/30/2006
Last Update Date: 09/30/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

410 LAKEVILLE RD SUITE 105 NS-LIJ COHEN CHILDREN'S MEDICAL CENTER OF NY
NEW HYDE PARK NY
11042
US

IV. Provider business mailing address

410 LAKEVILLE RD SUITE 105 NS-LIJ COHEN CHILDREN'S MEDICAL CENTER OF NY
NEW HYDE PARK NY
11042
US

V. Phone/Fax

Practice location:
  • Phone: 516-465-5255
  • Fax: 718-347-2240
Mailing address:
  • Phone: 516-465-5255
  • Fax: 718-347-2240

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberF381218-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: