Healthcare Provider Details

I. General information

NPI: 1669537064
Provider Name (Legal Business Name): PAULINE HUANG O.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/26/2006
Last Update Date: 02/12/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

99 ELIZABETH ST FL 2
NEW YORK NY
10013-4729
US

IV. Provider business mailing address

99 ELIZABETH ST FL 2
NEW YORK NY
10013-4729
US

V. Phone/Fax

Practice location:
  • Phone: 212-226-8837
  • Fax: 212-227-4651
Mailing address:
  • Phone: 212-227-8837
  • Fax: 212-227-4651

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberTUV006835
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: