Basic Information
| Provider Information | |||||||||
| NPI: | 1003802547 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | JUANG | ||||||||
| FirstName: | GEORGE | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 13630 MAPLE AVE STE 1G | ||||||||
| Address2: | |||||||||
| City: | FLUSHING | ||||||||
| State: | NY | ||||||||
| PostalCode: | 113553869 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7183003368 | ||||||||
| FaxNumber: | 7188887906 | ||||||||
| Practice Location | |||||||||
| Address1: | 13630 MAPLE AVE STE 1G | ||||||||
| Address2: | |||||||||
| City: | FLUSHING | ||||||||
| State: | NY | ||||||||
| PostalCode: | 113553869 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7183003368 | ||||||||
| FaxNumber: | 7188887906 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/20/2005 | ||||||||
| LastUpdateDate: | 06/16/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 174400000X | 206004-1 | NY | N | Other Service Providers | Specialist | 207RC0000X | 206004 | NY | N | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease | 207RC0001X | 206004 | NY | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Clinical Cardiac Electrophysiology |
ID Information
| ID | Type | State | Issuer | Description | 02280977 | 05 | NY | MEDICAID |