Provider Demographics
NPI:1245481555
Name:HUANG, DARA (MD, MMSC)
Entity type:Individual
Prefix:
First Name:DARA
Middle Name:
Last Name:HUANG
Suffix:
Gender:F
Credentials:MD, MMSC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:399 E 78TH ST
Mailing Address - Street 2:APT 2D
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10075-1383
Mailing Address - Country:US
Mailing Address - Phone:917-364-4885
Mailing Address - Fax:917-688-2444
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
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-06
Last Update Date:2016-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY250051207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYG400258792Medicare PIN
NYA4000059593Medicare PIN
NYA400132519Medicare PIN
NYA400053539Medicare PIN