Provider Demographics
NPI:1003802547
Name:JUANG, GEORGE (MD)
Entity Type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:
Last Name:JUANG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13630 MAPLE AVE STE 1G
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11355-3869
Mailing Address - Country:US
Mailing Address - Phone:718-300-3368
Mailing Address - Fax:718-888-7906
Practice Address - Street 1:13630 MAPLE AVE STE 1G
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11355-3869
Practice Address - Country:US
Practice Address - Phone:718-300-3368
Practice Address - Fax:718-888-7906
Is Sole Proprietor?:No
Enumeration Date:2005-09-20
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY206004-1174400000X
NY206004207RC0000X, 207RC0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0001XAllopathic & Osteopathic PhysiciansInternal MedicineClinical Cardiac Electrophysiology
No174400000XOther Service ProvidersSpecialist
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02280977Medicaid
NY02280977Medicaid
NY5146E1Medicare ID - Type Unspecified