Healthcare Provider Details

I. General information

NPI: 1265530422
Provider Name (Legal Business Name): HANSON HSU MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/20/2006
Last Update Date: 06/30/2023
Certification Date: 06/30/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

525 E 68TH ST # M130
NEW YORK NY
10065-4870
US

IV. Provider business mailing address

1175 YORK AVE # PHA7
NEW YORK NY
10065-7169
US

V. Phone/Fax

Practice location:
  • Phone: 212-746-0780
  • Fax:
Mailing address:
  • Phone: 212-689-7475
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number208851
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number25MA06928900
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: