Provider Demographics
NPI:1841231057
Name:HUANG, ZHENG-BO (MD)
Entity Type:Individual
Prefix:
First Name:ZHENG-BO
Middle Name:
Last Name:HUANG
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 1:14218 38TH AVE
Mailing Address - Street 2:SUITE 1C
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11354-5550
Mailing Address - Country:US
Mailing Address - Phone:718-888-1722
Mailing Address - Fax:718-888-1793
Practice Address - Street 1:14218 38TH AVE
Practice Address - Street 2:SUITE 1C
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11354-5550
Practice Address - Country:US
Practice Address - Phone:718-888-1722
Practice Address - Fax:718-888-1793
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-09
Last Update Date:2011-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY203908207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01867683Medicaid
NYG44789Medicare UPIN
NY01867683Medicaid