Provider Demographics
NPI:1629337811
Name:NG, BRIAN (LAC)
Entity Type:Individual
Prefix:
First Name:BRIAN
Middle Name:
Last Name:NG
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:338 JERICHO TPKE # 318
Mailing Address - Street 2:
Mailing Address - City:SYOSSET
Mailing Address - State:NY
Mailing Address - Zip Code:11791-4507
Mailing Address - Country:US
Mailing Address - Phone:646-580-3210
Mailing Address - Fax:
Practice Address - Street 1:139 FULTON ST RM 208
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10038-2538
Practice Address - Country:US
Practice Address - Phone:212-729-8565
Practice Address - Fax:845-595-8220
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-09
Last Update Date:2022-06-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY25004807171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist