Healthcare Provider Details

I. General information

NPI: 1003342718
Provider Name (Legal Business Name): ALVIN MAN-HAO HO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/02/2017
Last Update Date: 10/08/2020
Certification Date: 10/08/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 TYRELLAN AVE
STATEN ISLAND NY
10309-2624
US

IV. Provider business mailing address

101 TYRELLAN AVE STE 401
STATEN ISLAND NY
10309-2624
US

V. Phone/Fax

Practice location:
  • Phone: 929-292-3600
  • Fax: 929-292-3601
Mailing address:
  • Phone: 929-292-3600
  • Fax: 929-292-3601

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License Number304412-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: