Provider Demographics
NPI:1679658413
Name:HOANG, CHRISTY THUY (OD)
Entity Type:Individual
Prefix:
First Name:CHRISTY
Middle Name:THUY
Last Name:HOANG
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:215 US HIGHWAY 22 EAST
Mailing Address - Street 2:
Mailing Address - City:GREEN BROOK
Mailing Address - State:NJ
Mailing Address - Zip Code:08812
Mailing Address - Country:US
Mailing Address - Phone:732-968-4114
Mailing Address - Fax:
Practice Address - Street 1:215 US HIGHWAY 22 EAST
Practice Address - Street 2:
Practice Address - City:GREEN BROOK
Practice Address - State:NJ
Practice Address - Zip Code:08812-1920
Practice Address - Country:US
Practice Address - Phone:732-968-4114
Practice Address - Fax:732-968-6966
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-26
Last Update Date:2007-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ27OA00604500152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ110988WKLMedicare PIN