Provider Demographics
NPI:1831196898
Name:NGUYEN, DUSTIN TRIET (MD)
Entity type:Individual
Prefix:DR
First Name:DUSTIN
Middle Name:TRIET
Last Name:NGUYEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1436
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10013-0868
Mailing Address - Country:US
Mailing Address - Phone:212-334-7475
Mailing Address - Fax:212-334-5702
Practice Address - Street 1:202 CANAL ST
Practice Address - Street 2:FL 7
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10013-4517
Practice Address - Country:US
Practice Address - Phone:212-334-7475
Practice Address - Fax:212-334-5702
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-06
Last Update Date:2016-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY198018207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01618524Medicaid
NY397203Medicare ID - Type Unspecified
G20701Medicare UPIN