Provider Demographics
NPI:1336140433
Name:NG, JOHN PAUL TRACY (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN PAUL
Middle Name:TRACY
Last Name:NG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:408 BROADWAY
Mailing Address - Street 2:1ST FLOOR
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10013-3699
Mailing Address - Country:US
Mailing Address - Phone:212-925-8882
Mailing Address - Fax:212-925-8883
Practice Address - Street 1:408 BROADWAY
Practice Address - Street 2:1ST FLOOR
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10013-3699
Practice Address - Country:US
Practice Address - Phone:212-925-8882
Practice Address - Fax:212-925-8883
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-10
Last Update Date:2014-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1823212085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01466595Medicaid
NY02L841Medicare ID - Type Unspecified
F40088Medicare UPIN