MEDICARE: MR. RANDY NG

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TS0200X	School Psychologist	1784135	NY

General Provider Information

NPI Number	:	1144561440
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. RANDY NG

Provider Business Mailing Address
First Line	:	400 MOUNTAINVIEW AVE
Second Line	:
City	:	STATEN ISLAND
State	:	NY
Zip	:	10314-5280
Country	:	US
Telephone Number	:	646-637-1827
Fax Number	:

Provider Business Practice Location Address
First Line	:	167 DIVISION AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11211-7105
Country	:	US
Telephone Number	:	646-637-1827
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/12/2013
Last Update Date	:	03/12/2013

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Directions to “ MR. RANDY NG ” Practice Location

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