Healthcare Provider Details

I. General information

NPI: 1669708186
Provider Name (Legal Business Name): JACK YU JEN HUANG M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/19/2009
Last Update Date: 07/25/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1305 YORK AVE 7TH FLOOR
NEW YORK NY
10021-5663
US

IV. Provider business mailing address

61 BURNS ST
FOREST HILLS NY
11375-5226
US

V. Phone/Fax

Practice location:
  • Phone: 646-962-3325
  • Fax:
Mailing address:
  • Phone: 212-203-6709
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VE0102X
TaxonomyReproductive Endocrinology Physician
License Number60P70356
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: