Provider Demographics
NPI:1326177759
Name:NG, MICHELLE LEONG (DDS, MS)
Entity Type:Individual
Prefix:DR
First Name:MICHELLE
Middle Name:LEONG
Last Name:NG
Suffix:
Gender:F
Credentials:DDS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:465 MAIN ST APT 10A
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10044-0185
Mailing Address - Country:US
Mailing Address - Phone:917-363-1436
Mailing Address - Fax:
Practice Address - Street 1:4505 FRANCIS LEWIS BLVD
Practice Address - Street 2:
Practice Address - City:BAYSIDE
Practice Address - State:NY
Practice Address - Zip Code:11361-3042
Practice Address - Country:US
Practice Address - Phone:718-279-0900
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0530171223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02797744Medicaid