Provider Demographics
NPI:1568047629
Name:HU, GUODONG (PHD)
Entity Type:Individual
Prefix:MR
First Name:GUODONG
Middle Name:
Last Name:HU
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:136 SUMMIT AVENUE
Mailing Address - Street 2:
Mailing Address - City:MONTVALE
Mailing Address - State:NJ
Mailing Address - Zip Code:07645
Mailing Address - Country:US
Mailing Address - Phone:201-825-0186
Mailing Address - Fax:201-825-0191
Practice Address - Street 1:136 SUMMIT AVENUE
Practice Address - Street 2:
Practice Address - City:MONTVALE
Practice Address - State:NJ
Practice Address - Zip Code:07645
Practice Address - Country:US
Practice Address - Phone:201-825-0186
Practice Address - Fax:201-825-0191
Is Sole Proprietor?:No
Enumeration Date:2021-03-10
Last Update Date:2021-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYHUXXG1247ZC0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247ZC0005XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyClinical Laboratory Director, Non-physician