=====================================================
General NPI Number Information
=====================================================
NPI Number | 1780832642
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | NATHALIE Q NGUYEN,MD PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/04/2008
-----------------------------------------------------
Last Update Date | 03/24/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 19 MURRAY ST
-----------------------------------------------------
City | NEW YORK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10007-2240
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 212-233-2995
-----------------------------------------------------
Fax | 212-227-6577
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 19 MURRAY ST
-----------------------------------------------------
City | NEW YORK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10007-2240
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 212-233-2995
-----------------------------------------------------
Fax | 212-227-6577
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. NATHALIE Q NGUYEN
-----------------------------------------------------
Credential | MD,PLLC
-----------------------------------------------------
Telephone | 212-233-2995
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 174400000X
-----------------------------------------------------
Taxonomy Name | Specialist
-----------------------------------------------------
License Number | 225243
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------