Provider Demographics
NPI:1639351232
Name:LUONG, THANH-HA (MD)
Entity Type:Individual
Prefix:DR
First Name:THANH-HA
Middle Name:
Last Name:LUONG
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 1:305 E 24TH ST
Mailing Address - Street 2:18-E
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10010-4011
Mailing Address - Country:US
Mailing Address - Phone:212-995-1682
Mailing Address - Fax:
Practice Address - Street 1:1650 GRAND CONCOURSE
Practice Address - Street 2:1650 SELWYN AVENUE, 2ND FLOOR
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10457-7606
Practice Address - Country:US
Practice Address - Phone:718-239-8359
Practice Address - Fax:718-579-3901
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-05
Last Update Date:2009-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY209847207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01925593Medicaid
NY209847OtherLICENSE
NY01925593Medicaid
NY55N891Medicare PIN