Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080P0208X | Pediatric Infectious Diseases | 189894 | NY |
NPI | 1568808814 |
---|---|
Provider Name | Quoc Van Nguyen |
First Address | Manlius, NY 13104-9348 |
Second Address | Manlius, NY 13104-9348 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 14/05/2013 |
Last Update Date | 14/05/2013 |