Healthcare Provider Details

I. General information

NPI: 1730615519
Provider Name (Legal Business Name): LENNY NGUYEN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/11/2017
Last Update Date: 07/31/2020
Certification Date: 07/31/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

155 MINEOLA BLVD
MINEOLA NY
11501-3920
US

IV. Provider business mailing address

80 N CENTRE AVE APT PH409
ROCKVILLE CENTRE NY
11570-3990
US

V. Phone/Fax

Practice location:
  • Phone: 516-741-3338
  • Fax:
Mailing address:
  • Phone: 267-983-7211
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code213EP1101X
TaxonomyPrimary Podiatric Medicine Podiatrist
License Number007118
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code213ES0000X
TaxonomySports Medicine Podiatrist
License Number007118
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code213ES0131X
TaxonomyFoot Surgery Podiatrist
License Number007118
License Number StateNY
# 4
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number007118
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: