Healthcare Provider Details

I. General information

NPI: 1275819237
Provider Name (Legal Business Name): MY-NGOC NGUYEN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/22/2011
Last Update Date: 10/22/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3636 33RD ST SUITE 500
LONG ISLAND CITY NY
11106-2329
US

IV. Provider business mailing address

7609 4TH AVE APT. E7
BROOKLYN NY
11209-3238
US

V. Phone/Fax

Practice location:
  • Phone: 212-589-1227
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225XG0600X
TaxonomyGerontology Occupational Therapist
License Number0138651
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number0138651
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: