Healthcare Provider Details

I. General information

NPI: 1316690944
Provider Name (Legal Business Name): KELLY HUANG DNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/02/2022
Last Update Date: 02/02/2022
Certification Date: 02/02/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1275 YORK AVE
NEW YORK NY
10065-6007
US

IV. Provider business mailing address

1841 SHORE PKWY
BROOKLYN NY
11214-6619
US

V. Phone/Fax

Practice location:
  • Phone: 212-639-2000
  • Fax:
Mailing address:
  • Phone: 917-361-5487
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License NumberF432159-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: