Healthcare Provider Details

I. General information

NPI: 1750065777
Provider Name (Legal Business Name): HTAT AYE AUNG MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/12/2023
Last Update Date: 07/26/2026
Certification Date: 07/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

355 BARD AVE
STATEN ISLAND NY
10310-1699
US

IV. Provider business mailing address

355 BARD AVE DEPARTMENT OF MEDICINE
STATEN ISLAND NY
10310-1699
US

V. Phone/Fax

Practice location:
  • Phone: 844-934-2273
  • Fax:
Mailing address:
  • Phone: 718-818-1234
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number345983
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: