Healthcare Provider Details

I. General information

NPI: 1144736851
Provider Name (Legal Business Name): GEORGE H HSU
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/18/2017
Last Update Date: 12/18/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1890 OLD COUNTRY RD
RIVERHEAD NY
11901-4453
US

IV. Provider business mailing address

1890 OLD COUNTRY RD
RIVERHEAD NY
11901-4453
US

V. Phone/Fax

Practice location:
  • Phone: 631-369-9055
  • Fax: 631-727-2137
Mailing address:
  • Phone: 631-369-9055
  • Fax: 631-727-2137

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code156FX1800X
TaxonomyOptician
License Number008219
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: