Provider Demographics
NPI:1174597108
Name:HUYNH, THIEN THANH (MD)
Entity type:Individual
Prefix:
First Name:THIEN
Middle Name:THANH
Last Name:HUYNH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:140 EXECUTIVE DRIVE
Mailing Address - Street 2:SUITE 300
Mailing Address - City:NEW WINDSOR
Mailing Address - State:NY
Mailing Address - Zip Code:12553
Mailing Address - Country:US
Mailing Address - Phone:845-562-0138
Mailing Address - Fax:845-562-0147
Practice Address - Street 1:140 EXECUTIVE DRIVE
Practice Address - Street 2:SUITE 300
Practice Address - City:NEW WINDSOR
Practice Address - State:NY
Practice Address - Zip Code:12553
Practice Address - Country:US
Practice Address - Phone:845-562-0138
Practice Address - Fax:845-562-0147
Is Sole Proprietor?:No
Enumeration Date:2006-02-15
Last Update Date:2009-06-24
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY235785207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02751471Medicaid
NYI52535Medicare UPIN
NY02751471Medicaid