Provider Demographics
NPI:1780611087
Name:HSU, PECK PO-HSIUNG (MD)
Entity type:Individual
Prefix:DR
First Name:PECK
Middle Name:PO-HSIUNG
Last Name:HSU
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 1:971 HICKSVILLE RD
Mailing Address - Street 2:
Mailing Address - City:MASSAPEQUA
Mailing Address - State:NY
Mailing Address - Zip Code:11758-1252
Mailing Address - Country:US
Mailing Address - Phone:516-541-7393
Mailing Address - Fax:516-541-5313
Practice Address - Street 1:971 HICKSVILLE RD
Practice Address - Street 2:
Practice Address - City:MASSAPEQUA
Practice Address - State:NY
Practice Address - Zip Code:11758-1252
Practice Address - Country:US
Practice Address - Phone:516-541-7393
Practice Address - Fax:516-541-5313
Is Sole Proprietor?:No
Enumeration Date:2006-06-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY111311207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00418268Medicaid
NYB19843Medicare UPIN
NY899181Medicare ID - Type Unspecified