Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 2084N0400X | Neurologist | 25MA09265000 | NJ |
Y | 2084N0400X | Neurologist | MD445016 | PA |
NPI | 1003077074 |
---|---|
Provider Name | Dr. Ly Thien Ngo |
First Address | Philadelphia, PA 19107-5509 |
Second Address | Philadelphia, PA 19107-5509 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/06/2008 |
Last Update Date | 15/12/2014 |