Healthcare Provider Details

I. General information

NPI: 1104498815
Provider Name (Legal Business Name): SUHANG DUAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/13/2021
Last Update Date: 07/13/2021
Certification Date: 07/12/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

465 GRAND ST
NEW YORK NY
10002-4800
US

IV. Provider business mailing address

465 GRAND ST
NEW YORK NY
10002-4800
US

V. Phone/Fax

Practice location:
  • Phone: 646-645-8070
  • Fax: 212-420-1906
Mailing address:
  • Phone: 646-645-8070
  • Fax: 212-420-1906

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number112953
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: