Healthcare Provider Details

I. General information

NPI: 1568622827
Provider Name (Legal Business Name): JIAN QUN HUANG M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/11/2008
Last Update Date: 04/12/2021
Certification Date: 04/12/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

419 PARK AVE S RM 1305
NEW YORK NY
10016-8433
US

IV. Provider business mailing address

419 PARK AVE S RM 1305
NEW YORK NY
10016-8433
US

V. Phone/Fax

Practice location:
  • Phone: 212-545-5400
  • Fax: 212-447-1796
Mailing address:
  • Phone: 212-545-5400
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number254143-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: