Basic Information
| Provider Information | |||||||||
| NPI: | 1568491967 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HSU | ||||||||
| FirstName: | RICKY | ||||||||
| MiddleName: | K | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 8390 CHAMPIONS GATE BLVD | ||||||||
| Address2: | STE 215 | ||||||||
| City: | CHAMPIONS GATE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 338968310 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3214011364 | ||||||||
| FaxNumber: | 4073901765 | ||||||||
| Practice Location | |||||||||
| Address1: | 352 7TH AVE | ||||||||
| Address2: | RM 1205 | ||||||||
| City: | NEW YORK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 100015411 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2126277560 | ||||||||
| FaxNumber: | 2126277563 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/30/2006 | ||||||||
| LastUpdateDate: | 08/28/2017 | ||||||||
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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 | 207R00000X | 209946 | NY | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 02176474 | 05 | NY | MEDICAID |