Provider Demographics
NPI:1194766824
Name:HUO, JERRY (MD)
Entity type:Individual
Prefix:
First Name:JERRY
Middle Name:
Last Name:HUO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:38-08 UNION STREET, SUITE 3D
Mailing Address - Street 2:NY OTOLARYNGOLOGY PLLC
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11354
Mailing Address - Country:US
Mailing Address - Phone:718-670-0006
Mailing Address - Fax:718-701-5883
Practice Address - Street 1:38-08 UNION STREET, SUITE 3D
Practice Address - Street 2:NY OTOLARYNGOLOGY PLLC
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11354
Practice Address - Country:US
Practice Address - Phone:718-670-0006
Practice Address - Fax:718-701-5883
Is Sole Proprietor?:No
Enumeration Date:2006-06-10
Last Update Date:2023-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYNY192242207Y00000X
NY192242207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01769277Medicaid
NY01769277Medicaid
NY00669Medicare PIN
NY040396Medicare ID - Type Unspecified
NYG46703Medicare UPIN