1164491171 NPI number — DR. NIK G NG MD

Table of content: DR. NIK G NG MD (NPI 1164491171)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1164491171 NPI number — DR. NIK G NG MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
NG
Provider First Name:
NIK
Provider Middle Name:
G
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
NG
Provider Other First Name:
NIK
Provider Other Middle Name:
GRATITUDE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
MD
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1164491171
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/10/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2 CATHARINE STREET, P.O. BOX 550
Provider Second Line Business Mailing Address:
EAST MANHATTAN ANESTHESIA PARTNERS, LLC
Provider Business Mailing Address City Name:
POUGHKEEPSIE
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
12602
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
866-868-8415
Provider Business Mailing Address Fax Number:
845-790-2675

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
310 E 14TH STREET
Provider Second Line Business Practice Location Address:
NY EYE & EAR INFIRMARY
Provider Business Practice Location Address City Name:
NEW YORK
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10003
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
212-979-4464
Provider Business Practice Location Address Fax Number:
773-583-4295
Provider Enumeration Date:
03/14/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207L00000X , with the licence number:  267815-1NY , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 207L00000X , with the licence number: A96718 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207LC0200X , with the licence number: A96718 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207R00000X , with the licence number: A96718 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207L00000X , with the licence number: 267815 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 00A967180 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".




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