Provider Demographics
NPI:1477212777
Name:NGO, NINA (PA-C)
Entity Type:Individual
Prefix:
First Name:NINA
Middle Name:
Last Name:NGO
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:129 FRIENDSHIP RD
Mailing Address - Street 2:
Mailing Address - City:DREXEL HILL
Mailing Address - State:PA
Mailing Address - Zip Code:19026-5008
Mailing Address - Country:US
Mailing Address - Phone:610-955-3027
Mailing Address - Fax:
Practice Address - Street 1:700 COTTMAN AVE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19111-3062
Practice Address - Country:US
Practice Address - Phone:215-742-9900
Practice Address - Fax:215-742-7051
Is Sole Proprietor?:No
Enumeration Date:2021-12-14
Last Update Date:2021-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MP00663200363AM0700X
PAMA062763363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical