Provider Demographics
NPI:1063641074
Name:DUONG, NGUYET THUY (NURSE PRACTITIONER)
Entity Type:Individual
Prefix:MRS
First Name:NGUYET
Middle Name:THUY
Last Name:DUONG
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:MRS
Other - First Name:MOON
Other - Middle Name:
Other - Last Name:DUONG
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:NURSE PRACTITIONER
Mailing Address - Street 1:3336 71ST ST
Mailing Address - Street 2:
Mailing Address - City:JACKSON HEIGHTS
Mailing Address - State:NY
Mailing Address - Zip Code:11372-1057
Mailing Address - Country:US
Mailing Address - Phone:718-286-9176
Mailing Address - Fax:
Practice Address - Street 1:8635 QUEENS BLVD STE 1B
Practice Address - Street 2:
Practice Address - City:ELMHURST
Practice Address - State:NY
Practice Address - Zip Code:11373-4408
Practice Address - Country:US
Practice Address - Phone:718-286-9176
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-07-11
Last Update Date:2021-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY305140363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03435343Medicaid