Provider Demographics
NPI:1265895445
Name:NGUYEN, BIANCA BAOTRAN THAI (MD, MPH)
Entity type:Individual
Prefix:DR
First Name:BIANCA BAOTRAN
Middle Name:THAI
Last Name:NGUYEN
Suffix:
Gender:F
Credentials:MD, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:335 W 84TH ST APT 3
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10024-4229
Mailing Address - Country:US
Mailing Address - Phone:704-996-3831
Mailing Address - Fax:
Practice Address - Street 1:55 BROADWAY
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10006-3008
Practice Address - Country:US
Practice Address - Phone:646-315-2180
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-04
Last Update Date:2021-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY291320-012084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry