Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | X008941 | NY |
N | 111NI0013X | Independent Medical Examiner | X008941 | NY |
N | 111NR0400X | Rehabilitation Chiropractor | X008941 | NY |
NPI | 1407079791 |
---|---|
Provider Name | Dr. Charles Phong Nguyen |
First Address | Bronx, NY 10469-5720 |
Second Address | Bronx, NY 10469-5720 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 11/04/2007 |
Last Update Date | 21/04/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
02132236 | (05) | NY |
U74419 | (02) | NY |