Provider Demographics
NPI:1225137367
Name:NG, ANNEMARIE (MS, RD, CD/N)
Entity Type:Individual
Prefix:MRS
First Name:ANNEMARIE
Middle Name:
Last Name:NG
Suffix:
Gender:F
Credentials:MS, RD, CD/N
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?:Yes
Enumeration Date:2006-09-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY005897133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYP3553484OtherOXFORD
NY2498884OtherUNITED HEALTHCARE
NY9417E1Medicare ID - Type Unspecified