Healthcare Provider Details

I. General information

NPI: 1609525161
Provider Name (Legal Business Name): ANDY SHI HUANG MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/22/2022
Last Update Date: 03/22/2022
Certification Date: 03/22/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

310 E 14TH ST FL 1
NEW YORK NY
10003-4284
US

IV. Provider business mailing address

310 E 14TH ST FL 1
NEW YORK NY
10003-4284
US

V. Phone/Fax

Practice location:
  • Phone: 212-979-4192
  • Fax:
Mailing address:
  • Phone: 678-314-0208
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: