Healthcare Provider Details

I. General information

NPI: 1831545193
Provider Name (Legal Business Name): FRANK NGUYEN DO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/05/2016
Last Update Date: 08/09/2021
Certification Date: 08/09/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1715 E 13TH ST # 4
BROOKLYN NY
11229-1901
US

IV. Provider business mailing address

1715 E 13TH ST # 4
BROOKLYN NY
11229-1901
US

V. Phone/Fax

Practice location:
  • Phone: 718-258-2588
  • Fax: 718-258-2205
Mailing address:
  • Phone: 718-258-2588
  • Fax: 718-258-2205

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2081S0010X
TaxonomySports Medicine (Physical Medicine & Rehabilitation) Physician
License Number312299
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number312299
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: