=====================================================
General NPI Number Information
=====================================================
NPI Number | 1497200414
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | PAUL HUANG
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/19/2016
-----------------------------------------------------
Last Update Date | 08/19/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 8125 37TH AVE
-----------------------------------------------------
City | JACKSON HEIGHTS
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11372-6718
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 718-899-0200
-----------------------------------------------------
Fax | 718-899-0600
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5409 72ND ST
-----------------------------------------------------
City | MASPETH
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11378-1814
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 183500000X
-----------------------------------------------------
Taxonomy Name | Pharmacist
-----------------------------------------------------
License Number | 049798
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------