Healthcare Provider Details

I. General information

NPI: 1255968988
Provider Name (Legal Business Name): ALICE HUANG
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/24/2020
Last Update Date: 05/21/2025
Certification Date: 05/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

622 W 168TH ST # PB01-301
NEW YORK NY
10032-3720
US

IV. Provider business mailing address

622 W 168TH ST # PB01-301
NEW YORK NY
10032-3720
US

V. Phone/Fax

Practice location:
  • Phone: 212-305-4928
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number315866
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: