Healthcare Provider Details

I. General information

NPI: 1518162585
Provider Name (Legal Business Name): LUCY YAN XIONG HUANG PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/19/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

258 W 91ST STREET SUITE 1
NEW YORK NY
10024-1108
US

IV. Provider business mailing address

142-18 38TH AVE 2B
FLUSHING NY
11354-5551
US

V. Phone/Fax

Practice location:
  • Phone: 212-875-8345
  • Fax: 212-875-0143
Mailing address:
  • Phone: 718-461-9646
  • Fax: 718-461-9646

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number021121
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: