Healthcare Provider Details

I. General information

NPI: 1538632021
Provider Name (Legal Business Name): ANDY HUANG PA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/07/2019
Last Update Date: 11/18/2025
Certification Date: 11/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

202 CANAL ST STE 500
NEW YORK NY
10013-4517
US

IV. Provider business mailing address

202 CANAL ST STE 500
NEW YORK NY
10013-4517
US

V. Phone/Fax

Practice location:
  • Phone: 212-965-9888
  • Fax:
Mailing address:
  • Phone: 718-972-4608
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number023197
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: