Healthcare Provider Details

I. General information

NPI: 1285227215
Provider Name (Legal Business Name): JINA HUH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/20/2021
Last Update Date: 02/20/2021
Certification Date: 02/20/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

280 S MAIN ST
NEW CITY NY
10956-3327
US

IV. Provider business mailing address

275 PINE ST
WYCKOFF NJ
07481-2824
US

V. Phone/Fax

Practice location:
  • Phone: 845-639-8150
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number063676
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: