Provider Demographics
NPI:1588186639
Name:HU, SHIMENG (MD)
Entity Type:Individual
Prefix:DR
First Name:SHIMENG
Middle Name:
Last Name:HU
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 1:165 VANDERBILT AVE
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10304-2521
Mailing Address - Country:US
Mailing Address - Phone:718-616-0999
Mailing Address - Fax:979-256-0814
Practice Address - Street 1:165 VANDERBILT AVE
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10304-2521
Practice Address - Country:US
Practice Address - Phone:718-616-0999
Practice Address - Fax:979-256-0814
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-11
Last Update Date:2021-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
NY306850207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training ProgramGroup - Single Specialty