Healthcare Provider Details

I. General information

NPI: 1215079108
Provider Name (Legal Business Name): ANGELA C HUANG OD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/14/2007
Last Update Date: 04/24/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

239 E 84TH ST #1D
NEW YORK NY
10028-2955
US

IV. Provider business mailing address

239 E 84TH ST #1D
NEW YORK NY
10028-2955
US

V. Phone/Fax

Practice location:
  • Phone: 917-692-0672
  • Fax:
Mailing address:
  • Phone: 917-692-0672
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberTUV007124-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: