=====================================================
General NPI Number Information
=====================================================
NPI Number | 1043195357
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | KHOI TAM NGO LSW
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/06/2025
-----------------------------------------------------
Last Update Date | 08/06/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 333 IRVING AVENUE
-----------------------------------------------------
City | BRIDGETON
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 08302-2123
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 856-575-4288
-----------------------------------------------------
Fax | 856-497-5330
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 333 IRVING AVENUE
-----------------------------------------------------
City | BRIDGETON
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 08302-2123
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 856-575-4288
-----------------------------------------------------
Fax | 856-497-5330
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 104100000X
-----------------------------------------------------
Taxonomy Name | Social Worker
-----------------------------------------------------
License Number | 44SL06842900
-----------------------------------------------------
License Number State | NJ
-----------------------------------------------------