Healthcare Provider Details

I. General information

NPI: 1477071280
Provider Name (Legal Business Name): SCOTT HAN HUH PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/31/2017
Last Update Date: 09/14/2024
Certification Date: 09/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

525 E 68TH ST
NEW YORK NY
10065-4870
US

IV. Provider business mailing address

282 11TH AVE APT 504
NEW YORK NY
10001-1256
US

V. Phone/Fax

Practice location:
  • Phone: 203-520-5617
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number50.005176RX
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number031161
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: