Healthcare Provider Details

I. General information

NPI: 1114993748
Provider Name (Legal Business Name): NGOC L THAI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/24/2006
Last Update Date: 04/23/2026
Certification Date: 04/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

718 TEANECK RD
TEANECK NJ
07666-4245
US

IV. Provider business mailing address

3 UNIVERSITY PLZ STE 205
HACKENSACK NJ
07601-6208
US

V. Phone/Fax

Practice location:
  • Phone: 201-833-7110
  • Fax:
Mailing address:
  • Phone: 201-833-3000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code204F00000X
TaxonomyTransplant Surgery Physician
License Number2026-02200
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number25MA11968800
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: