=====================================================
General NPI Number Information
=====================================================
NPI Number | 1770751505
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ESTHER HUANG OD PA
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/14/2008
-----------------------------------------------------
Last Update Date | 03/31/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 106 GRAND AVE STE 470 4TH FLOOR
-----------------------------------------------------
City | ENGLEWOOD
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07631-3596
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 201-541-9494
-----------------------------------------------------
Fax | 201-871-7382
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 106 GRAND AVE STE 470 4TH FLOOR
-----------------------------------------------------
City | ENGLEWOOD
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07631-3596
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 201-541-9494
-----------------------------------------------------
Fax | 201-871-7382
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | ESTHER HUANG
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 201-541-9494
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 152W00000X
-----------------------------------------------------
Taxonomy Name | Optometrist
-----------------------------------------------------
License Number | 27OA00575700
-----------------------------------------------------
License Number State | NJ
-----------------------------------------------------