Provider Demographics
NPI:1467474494
Name:NGO, GEORGE K (DC)
Entity Type:Individual
Prefix:MR
First Name:GEORGE
Middle Name:K
Last Name:NGO
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:77 PASSAIC ST
Mailing Address - Street 2:
Mailing Address - City:GARFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07026-3138
Mailing Address - Country:US
Mailing Address - Phone:973-777-7177
Mailing Address - Fax:973-777-4698
Practice Address - Street 1:77 PASSAIC ST
Practice Address - Street 2:
Practice Address - City:GARFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07026-3138
Practice Address - Country:US
Practice Address - Phone:973-777-7177
Practice Address - Fax:973-777-4698
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-25
Last Update Date:2011-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00135000111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ384240101Medicaid
NJT45689Medicare ID - Type Unspecified