Provider Demographics
NPI:1255586129
Name:NG, DENNIS GO (DPT, MBA, MS, CLT)
Entity type:Individual
Prefix:DR
First Name:DENNIS
Middle Name:GO
Last Name:NG
Suffix:
Gender:M
Credentials:DPT, MBA, MS, CLT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4902 TOWNLINE RD
Mailing Address - Street 2:
Mailing Address - City:MEDINA
Mailing Address - State:NY
Mailing Address - Zip Code:14103-9744
Mailing Address - Country:US
Mailing Address - Phone:585-831-6355
Mailing Address - Fax:
Practice Address - Street 1:500 SENECA ST STE 100
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14204
Practice Address - Country:US
Practice Address - Phone:716-449-0446
Practice Address - Fax:716-408-8863
Is Sole Proprietor?:No
Enumeration Date:2008-11-19
Last Update Date:2018-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070010850225100000X
NY0388902251G0304X, 225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2251G0304XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGeriatrics