Provider Demographics
NPI:1659468775
Name:HWANG, SHAW-FU (MD)
Entity Type:Individual
Prefix:DR
First Name:SHAW-FU
Middle Name:
Last Name:HWANG
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 1:20 CAMBRIDGE RD
Mailing Address - Street 2:
Mailing Address - City:SCARSDALE
Mailing Address - State:NY
Mailing Address - Zip Code:10583-2152
Mailing Address - Country:US
Mailing Address - Phone:914-725-2164
Mailing Address - Fax:914-725-2569
Practice Address - Street 1:2 MOTT ST
Practice Address - Street 2:#204
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10013-5003
Practice Address - Country:US
Practice Address - Phone:212-227-4505
Practice Address - Fax:212-227-4598
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY121546208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00373877Medicaid
NY06A462Medicare ID - Type Unspecified
NY00373877Medicaid