Healthcare Provider Details

I. General information

NPI: 1346486594
Provider Name (Legal Business Name): GANG MENG M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/17/2008
Last Update Date: 06/23/2023
Certification Date: 06/23/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5521 8TH AVE UNIT 4A
BROOKLYN NY
11220-3515
US

IV. Provider business mailing address

5521 8TH AVE UNIT 4A
BROOKLYN NY
11220-3515
US

V. Phone/Fax

Practice location:
  • Phone: 347-663-1255
  • Fax: 718-633-8898
Mailing address:
  • Phone: 646-683-0005
  • Fax: 718-633-8898

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number250354
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: