Provider Demographics
NPI:1629109582
Name:HO, PHUONG TU (PA)
Entity Type:Individual
Prefix:MISS
First Name:PHUONG
Middle Name:TU
Last Name:HO
Suffix:
Gender:F
Credentials:PA
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Mailing Address - Street 1:55 WATER STREET
Mailing Address - Street 2:2ND FLOOR CRED DEPT
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10041-0004
Mailing Address - Country:US
Mailing Address - Phone:646-680-2888
Mailing Address - Fax:516-542-5556
Practice Address - Street 1:233 NOSTRAND AVENUE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11205
Practice Address - Country:US
Practice Address - Phone:718-403-3547
Practice Address - Fax:718-858-0145
Is Sole Proprietor?:No
Enumeration Date:2007-03-09
Last Update Date:2019-09-12
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Provider Licenses
StateLicense IDTaxonomies
NY011675363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY011675OtherLICENSE