Provider Demographics
NPI:1710332952
Name:NGUYEN DERMATOLOGY PC
Entity Type:Organization
Organization Name:NGUYEN DERMATOLOGY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CHAU
Authorized Official - Middle Name:
Authorized Official - Last Name:NGUYEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:631-403-2375
Mailing Address - Street 1:PO BOX 1064
Mailing Address - Street 2:
Mailing Address - City:EAST NORTHPORT
Mailing Address - State:NY
Mailing Address - Zip Code:11731-0543
Mailing Address - Country:US
Mailing Address - Phone:631-403-2375
Mailing Address - Fax:
Practice Address - Street 1:181 MAIN ST
Practice Address - Street 2:SUITE 201
Practice Address - City:HUNTINGTON
Practice Address - State:NY
Practice Address - Zip Code:11743-6918
Practice Address - Country:US
Practice Address - Phone:631-403-2375
Practice Address - Fax:206-339-7108
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-25
Last Update Date:2016-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY247136261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty