Provider Demographics
NPI:1154777282
Name:DARA HUANG MD MEDICAL PLLC
Entity type:Organization
Organization Name:DARA HUANG MD MEDICAL PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:DARA
Authorized Official - Middle Name:
Authorized Official - Last Name:HUANG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:917-364-4885
Mailing Address - Street 1:399 E 78TH ST
Mailing Address - Street 2:2D
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10075-1383
Mailing Address - Country:US
Mailing Address - Phone:646-541-1181
Mailing Address - Fax:
Practice Address - Street 1:139 CENTRE ST
Practice Address - Street 2:SUITE 515
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10013-4552
Practice Address - Country:US
Practice Address - Phone:917-364-4885
Practice Address - Fax:917-688-2444
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-08
Last Update Date:2016-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY250051207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03433410Medicaid
NYA4000059593Medicare PIN
NY03433410Medicaid
NYG400258792Medicare PIN
NYA4000053539Medicare PIN