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General NPI Number Information
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NPI Number | 1225471147
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Entity Type | Organization
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Legal Business Name | DR TAM NGUYEN LLC
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Dates
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Enumeration Date | 04/10/2013
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Last Update Date | 04/10/2013
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Provider Practice Location Address
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Address Line | 45 RIVINGTON STREET
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City | NEW YORK
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State | NY
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Zip | 10002
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Country | US
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Telephone | 212-539-6206
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Fax |
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Provider Business Mailing Address
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Address Line | 3081 EDWIN AVE 2J
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City | FORT LEE
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State | NJ
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Zip | 07024
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Country | US
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Telephone | 617-347-3465
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. TAM NGUYEN
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Credential | OD
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Telephone | 617-347-3465
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | TUV007248-1
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License Number State | NY
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