Healthcare Provider Details

I. General information

NPI: 1912837055
Provider Name (Legal Business Name): DYLAN NG
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/20/2026
Last Update Date: 05/21/2026
Certification Date: 05/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

32 LARCH DR
NEW HYDE PARK NY
11040-2344
US

IV. Provider business mailing address

32 LARCH DR
NEW HYDE PARK NY
11040-2344
US

V. Phone/Fax

Practice location:
  • Phone: 516-302-5803
  • Fax:
Mailing address:
  • Phone: 516-302-5803
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License Number345709-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: