Provider Demographics
NPI:1720434897
Name:NG, SOW FONG
Entity Type:Individual
Prefix:
First Name:SOW FONG
Middle Name:
Last Name:NG
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:821 45TH ST STE 101
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11220-5286
Mailing Address - Country:US
Mailing Address - Phone:718-972-1233
Mailing Address - Fax:718-972-1277
Practice Address - Street 1:821 45TH ST STE 101
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11220-5286
Practice Address - Country:US
Practice Address - Phone:718-972-1233
Practice Address - Fax:718-972-1277
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-09
Last Update Date:2020-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY021232363A00000X
FLPA 9109055363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL10652Medicare PIN