Healthcare Provider Details

I. General information

NPI: 1649286279
Provider Name (Legal Business Name): CLARK HUANG M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/01/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

115 E 57TH ST SUITE 600
NEW YORK NY
10022-2049
US

IV. Provider business mailing address

115 EAST 57TH STREET SUITE 600
NEW YORK NY
10022
US

V. Phone/Fax

Practice location:
  • Phone: 212-308-7333
  • Fax: 212-832-3287
Mailing address:
  • Phone: 212-308-7333
  • Fax: 212-832-3287

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number203622
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: