Healthcare Provider Details

I. General information

NPI: 1023336732
Provider Name (Legal Business Name): CHENCHAN HUANG M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/06/2010
Last Update Date: 05/19/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

660 1ST AVE 3RD FLOOR
NEW YORK NY
10016-3295
US

IV. Provider business mailing address

5906 41ST AVE 1ST FLOOR
WOODSIDE NY
11377-4842
US

V. Phone/Fax

Practice location:
  • Phone: 212-263-0232
  • Fax:
Mailing address:
  • Phone: 917-353-3396
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number265688
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: