Provider Demographics
NPI:1245220490
Name:HUFNAGEL, THIERRY JOHN (MD)
Entity Type:Individual
Prefix:
First Name:THIERRY
Middle Name:JOHN
Last Name:HUFNAGEL
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 1:148 BRITE AVE
Mailing Address - Street 2:
Mailing Address - City:SCARSDALE
Mailing Address - State:NY
Mailing Address - Zip Code:10583-1427
Mailing Address - Country:US
Mailing Address - Phone:914-725-3536
Mailing Address - Fax:
Practice Address - Street 1:450 ENDO BLVD
Practice Address - Street 2:
Practice Address - City:GARDEN CITY
Practice Address - State:NY
Practice Address - Zip Code:11530-6723
Practice Address - Country:US
Practice Address - Phone:516-832-8000
Practice Address - Fax:516-832-8379
Is Sole Proprietor?:No
Enumeration Date:2005-10-27
Last Update Date:2015-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1933291207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01444715Medicaid
NY83H331Medicare ID - Type Unspecified
NY01444715Medicaid