Healthcare Provider Details

I. General information

NPI: 1679164834
Provider Name (Legal Business Name): TOMMY HUANG
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/31/2021
Last Update Date: 01/31/2021
Certification Date: 01/31/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

525 E 68TH ST
NEW YORK NY
10065
US

IV. Provider business mailing address

1578 73RD STREET
BROOKLYN NY
11228
US

V. Phone/Fax

Practice location:
  • Phone: 212-746-5454
  • Fax:
Mailing address:
  • Phone: 646-410-5032
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number067506
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: