1992320725 NPI number — THAO NGUYEN NURSE PRACTITIONER IN PSYCHIATRY PC

Table of content: (NPI 1992320725)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1992320725 NPI number — THAO NGUYEN NURSE PRACTITIONER IN PSYCHIATRY PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
THAO NGUYEN NURSE PRACTITIONER IN PSYCHIATRY PC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1992320725
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/07/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1070 MIDDLE COUNTRY RD STE 7-271
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SELDEN
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11784-2580
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
516-398-6691
Provider Business Mailing Address Fax Number:
631-318-6443

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
12 FAIRWOOD LN
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CORAM
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11727-3336
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
631-318-4004
Provider Business Practice Location Address Fax Number:
631-318-6443
Provider Enumeration Date:
06/08/2020

Additional Information

Authorized Official

Authorized Official Last Name:
NGUYEN
Authorized Official First Name:
THAO
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
631-318-4004

Provider Taxonomy Codes

  • Taxonomy code: 363LP0808X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 04591291 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".




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