Provider Demographics
NPI:1477630747
Name:HUANG, JI MING (MD)
Entity Type:Individual
Prefix:
First Name:JI MING
Middle Name:
Last Name:HUANG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:JI MING
Other - Middle Name:
Other - Last Name:HUANG
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:4647 MERRICK ROAD
Mailing Address - Street 2:
Mailing Address - City:MASSAPEQUA
Mailing Address - State:NY
Mailing Address - Zip Code:11758-6021
Mailing Address - Country:US
Mailing Address - Phone:516-799-7204
Mailing Address - Fax:516-799-6757
Practice Address - Street 1:4647 MERRICK ROAD
Practice Address - Street 2:
Practice Address - City:MASSAPEQUA
Practice Address - State:NY
Practice Address - Zip Code:11758-6021
Practice Address - Country:US
Practice Address - Phone:516-799-7204
Practice Address - Fax:516-799-6757
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1084571207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00411821Medicaid
C10022Medicare UPIN
NY00411821Medicaid