Provider Demographics
NPI:1063078541
Name:HUANG, JUAN (AGPCNP)
Entity type:Individual
Prefix:
First Name:JUAN
Middle Name:
Last Name:HUANG
Suffix:
Gender:F
Credentials:AGPCNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:366 5TH AVE FL 4
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10001-2241
Mailing Address - Country:US
Mailing Address - Phone:646-630-8266
Mailing Address - Fax:
Practice Address - Street 1:1867 86TH ST FL 1
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11214-3108
Practice Address - Country:US
Practice Address - Phone:718-872-7777
Practice Address - Fax:718-709-7792
Is Sole Proprietor?:No
Enumeration Date:2019-05-10
Last Update Date:2024-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF309041363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health