Healthcare Provider Details

I. General information

NPI: 1598463259
Provider Name (Legal Business Name): YITING HUANG PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: FERDY HUANG PA-C

II. Dates (important events)

Enumeration Date: 02/21/2023
Last Update Date: 11/22/2023
Certification Date: 11/22/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 ELMWOOD AVE
ROCHESTER NY
14642-1150
US

IV. Provider business mailing address

191 N MAIN ST
WELLSVILLE NY
14895-1150
US

V. Phone/Fax

Practice location:
  • Phone: 585-275-9555
  • Fax:
Mailing address:
  • Phone: 585-593-1100
  • Fax: 585-596-4005

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number029460
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: