Healthcare Provider Details

I. General information

NPI: 1093374779
Provider Name (Legal Business Name): ELLIOTT HUANG MD MPH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/06/2019
Last Update Date: 05/28/2025
Certification Date: 05/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3959 BROADWAY
NEW YORK NY
10032-1559
US

IV. Provider business mailing address

3959 BROADWAY
NEW YORK NY
10032-1559
US

V. Phone/Fax

Practice location:
  • Phone: 212-305-5825
  • Fax: 212-342-0518
Mailing address:
  • Phone: 212-305-5825
  • Fax: 212-342-0518

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0210X
TaxonomyPediatric Nephrology Physician
License Number319610
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: