Provider Demographics
NPI:1568744506
Name:TRUONG, TAI D
Entity Type:Individual
Prefix:MR
First Name:TAI
Middle Name:D
Last Name:TRUONG
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:476 W UNION AVE
Mailing Address - Street 2:
Mailing Address - City:BOUND BROOK
Mailing Address - State:NJ
Mailing Address - Zip Code:08805-1221
Mailing Address - Country:US
Mailing Address - Phone:732-805-4014
Mailing Address - Fax:732-805-4018
Practice Address - Street 1:476 W UNION AVE
Practice Address - Street 2:
Practice Address - City:BOUND BROOK
Practice Address - State:NJ
Practice Address - Zip Code:08805-1221
Practice Address - Country:US
Practice Address - Phone:732-805-4014
Practice Address - Fax:732-805-4018
Is Sole Proprietor?:No
Enumeration Date:2011-09-15
Last Update Date:2011-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI03114500183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist