Healthcare Provider Details

I. General information

NPI: 1386140713
Provider Name (Legal Business Name): PRISCILLA TING DO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/04/2018
Last Update Date: 09/08/2023
Certification Date: 09/08/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6136 170TH ST APT M4
FRESH MEADOWS NY
11365-1957
US

IV. Provider business mailing address

6136 170TH ST APT M4
FRESH MEADOWS NY
11365-1957
US

V. Phone/Fax

Practice location:
  • Phone: 718-709-0940
  • Fax:
Mailing address:
  • Phone: 718-709-0940
  • Fax: 330-363-4914

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number325734-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: