Provider Demographics
NPI:1275598575
Name:LY, HUE T (MD)
Entity Type:Individual
Prefix:
First Name:HUE
Middle Name:T
Last Name:LY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 OLD COUNTRY RD
Mailing Address - Street 2:SUITE 31
Mailing Address - City:MINEOLA
Mailing Address - State:NY
Mailing Address - Zip Code:11501-4198
Mailing Address - Country:US
Mailing Address - Phone:516-294-9380
Mailing Address - Fax:516-294-5351
Practice Address - Street 1:300 OLD COUNTRY RD
Practice Address - Street 2:SUITE 31
Practice Address - City:MINEOLA
Practice Address - State:NY
Practice Address - Zip Code:11501-4198
Practice Address - Country:US
Practice Address - Phone:516-294-9380
Practice Address - Fax:516-294-5351
Is Sole Proprietor?:No
Enumeration Date:2006-04-19
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY206566-1207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01831314Medicaid
NYP826521OtherOXFORD
NYBL5645708OtherDEA
NY30N301Medicare ID - Type Unspecified
NY01831314Medicaid