Healthcare Provider Details

I. General information

NPI: 1053638858
Provider Name (Legal Business Name): NGUYEN VO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/03/2010
Last Update Date: 11/01/2024
Certification Date: 11/01/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1925 PACIFIC AVE
ATLANTIC CITY NJ
08401-6713
US

IV. Provider business mailing address

1925 PACIFIC AVE
ATLANTIC CITY NJ
08401-6713
US

V. Phone/Fax

Practice location:
  • Phone: 609-441-8063
  • Fax: 609-484-7009
Mailing address:
  • Phone: 609-441-8063
  • Fax: 609-484-7009

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207ZC0500X
TaxonomyCytopathology Physician
License NumberMD450560
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code207ZC0500X
TaxonomyCytopathology Physician
License Number25MA09858900
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: