Provider Demographics
NPI:1942225479
Name:NGUYEN, HUNG MANH (MD)
Entity Type:Individual
Prefix:DR
First Name:HUNG
Middle Name:MANH
Last Name:NGUYEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:760 AMBOY AVE
Mailing Address - Street 2:
Mailing Address - City:EDISON
Mailing Address - State:NJ
Mailing Address - Zip Code:08837-3224
Mailing Address - Country:US
Mailing Address - Phone:732-661-0966
Mailing Address - Fax:732-738-4661
Practice Address - Street 1:760 AMBOY AVE
Practice Address - Street 2:
Practice Address - City:EDISON
Practice Address - State:NJ
Practice Address - Zip Code:08837-3224
Practice Address - Country:US
Practice Address - Phone:732-661-0966
Practice Address - Fax:732-738-4661
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-13
Last Update Date:2017-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA044119002080A0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ3484203Medicaid
NJD90510Medicare UPIN