Provider Demographics
NPI:1043462617
Name:J.T. HUANG, M.D. P.C
Entity Type:Organization
Organization Name:J.T. HUANG, M.D. P.C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:J
Authorized Official - Middle Name:T
Authorized Official - Last Name:HUANG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:570-258-0111
Mailing Address - Street 1:128 W WASHINGTON ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:NANTICOKE
Mailing Address - State:PA
Mailing Address - Zip Code:18634-3113
Mailing Address - Country:US
Mailing Address - Phone:570-258-0111
Mailing Address - Fax:570-258-0303
Practice Address - Street 1:128 W WASHINGTON ST
Practice Address - Street 2:SUITE A
Practice Address - City:NANTICOKE
Practice Address - State:PA
Practice Address - Zip Code:18634-3113
Practice Address - Country:US
Practice Address - Phone:570-258-0111
Practice Address - Fax:570-258-0303
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-15
Last Update Date:2008-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA207Q00000XMedicaid