Provider Demographics
NPI:1134127616
Name:NG, CHRISTOPHER (MD)
Entity Type:Individual
Prefix:DR
First Name:CHRISTOPHER
Middle Name:
Last Name:NG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 S JERSEY AVE
Mailing Address - Street 2:SUITE 14
Mailing Address - City:SETAUKET
Mailing Address - State:NY
Mailing Address - Zip Code:11733-2034
Mailing Address - Country:US
Mailing Address - Phone:631-751-3883
Mailing Address - Fax:631-751-3909
Practice Address - Street 1:100 S JERSEY AVE
Practice Address - Street 2:SUITE 14
Practice Address - City:SETAUKET
Practice Address - State:NY
Practice Address - Zip Code:11733-2034
Practice Address - Country:US
Practice Address - Phone:631-751-3883
Practice Address - Fax:631-751-3909
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY211195207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYH24272Medicare UPIN
NY20V901Medicare ID - Type Unspecified