Provider Demographics
NPI:1669916631
Name:HA, NGOC-LAN (NP)
Entity type:Individual
Prefix:
First Name:NGOC-LAN
Middle Name:
Last Name:HA
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:236 AUSTIN RYER LN
Mailing Address - Street 2:
Mailing Address - City:BRANFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06405-2679
Mailing Address - Country:US
Mailing Address - Phone:718-730-0837
Mailing Address - Fax:
Practice Address - Street 1:404 LUDINGTONVILLE RD
Practice Address - Street 2:
Practice Address - City:HOLMES
Practice Address - State:NY
Practice Address - Zip Code:12531-4626
Practice Address - Country:US
Practice Address - Phone:845-878-3241
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-12-11
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF339542363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily