Healthcare Provider Details

I. General information

NPI: 1124384714
Provider Name (Legal Business Name): JONATHAN HUZ M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/08/2012
Last Update Date: 08/09/2021
Certification Date: 08/09/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1220 NEW SCOTLAND RD SUITE 201
SLINGERLANDS NY
12159-9396
US

IV. Provider business mailing address

1220 NEW SCOTLAND RD SUITE 201
SLINGERLANDS NY
12159-9396
US

V. Phone/Fax

Practice location:
  • Phone: 518-533-6550
  • Fax: 518-533-6556
Mailing address:
  • Phone: 518-533-6550
  • Fax: 518-533-6556

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number283416
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number042.0013494
License Number StateVT
# 3
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number266886
License Number StateMA
# 4
Primary TaxonomyY
Taxonomy Code207WX0107X
TaxonomyRetina Specialist (Ophthalmology) Physician
License Number283416
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: