Healthcare Provider Details

I. General information

NPI: 1164491171
Provider Name (Legal Business Name): NIK G NG MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: NIK GRATITUDE NG MD

II. Dates (important events)

Enumeration Date: 03/14/2006
Last Update Date: 08/06/2025
Certification Date: 08/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

621 10TH ST
NIAGARA FALLS NY
14301-1813
US

IV. Provider business mailing address

2 CATHARINE STREET, P.O. BOX 550 EAST MANHATTAN ANESTHESIA PARTNERS, LLC
POUGHKEEPSIE NY
12602
US

V. Phone/Fax

Practice location:
  • Phone: 716-278-4000
  • Fax:
Mailing address:
  • Phone: 866-868-8415
  • Fax: 845-790-2675

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberA96718
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number267815
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code207LC0200X
TaxonomyCritical Care Medicine (Anesthesiology) Physician
License NumberA96718
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberA96718
License Number StateCA
# 5
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number267815-1NY
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: