Provider Demographics
NPI:1730613043
Name:HUANG, DONGMEI
Entity type:Individual
Prefix:
First Name:DONGMEI
Middle Name:
Last Name:HUANG
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6202 16TH AVE
Mailing Address - Street 2:GROUND FL
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11204-2701
Mailing Address - Country:US
Mailing Address - Phone:347-556-0399
Mailing Address - Fax:
Practice Address - Street 1:6202 16TH AVE
Practice Address - Street 2:GROUND FL
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11204-2701
Practice Address - Country:US
Practice Address - Phone:347-556-0399
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-04-13
Last Update Date:2017-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY160620010323172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY812991531Medicaid