Healthcare Provider Details

I. General information

NPI: 1366585671
Provider Name (Legal Business Name): PETER M HWANG DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/15/2007
Last Update Date: 09/05/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

133 MORNINGSIDE AVE
NEW YORK NY
10027-4802
US

IV. Provider business mailing address

188 FAIRVIEW AVE
ENGLEWOOD CLIFFS NJ
07632-2016
US

V. Phone/Fax

Practice location:
  • Phone: 212-923-2525
  • Fax: 646-981-9457
Mailing address:
  • Phone: 917-699-9147
  • Fax: 201-346-9206

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number048069
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: