Provider Demographics
NPI:1720256951
Name:HUANG, MICHAEL BAILOU (LAC)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:BAILOU
Last Name:HUANG
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 LYNDON LN
Mailing Address - Street 2:
Mailing Address - City:SOUTH SETAUKET
Mailing Address - State:NY
Mailing Address - Zip Code:11720-1211
Mailing Address - Country:US
Mailing Address - Phone:631-320-1102
Mailing Address - Fax:
Practice Address - Street 1:15 LYNDON LN
Practice Address - Street 2:
Practice Address - City:SOUTH SETAUKET
Practice Address - State:NY
Practice Address - Zip Code:11720-1211
Practice Address - Country:US
Practice Address - Phone:631-320-1102
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-11
Last Update Date:2008-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY003687171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist