Provider Demographics
NPI:1922255769
Name:NG, EDWARD C (RPH)
Entity Type:Individual
Prefix:MR
First Name:EDWARD
Middle Name:C
Last Name:NG
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16406 69TH AVE
Mailing Address - Street 2:
Mailing Address - City:FRESH MEADOWS
Mailing Address - State:NY
Mailing Address - Zip Code:11365-3202
Mailing Address - Country:US
Mailing Address - Phone:718-380-3330
Mailing Address - Fax:718-380-4401
Practice Address - Street 1:16406 69TH AVE
Practice Address - Street 2:
Practice Address - City:FRESH MEADOWS
Practice Address - State:NY
Practice Address - Zip Code:11365-3202
Practice Address - Country:US
Practice Address - Phone:718-380-3330
Practice Address - Fax:718-380-4401
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-23
Last Update Date:2008-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY040295183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist