Basic Information
Provider Information
NPI: 1003297102
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: NG
FirstName: MARCUS
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential: MD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 300 COMMUNITY DR
Address2:  
City: MANHASSET
State: NY
PostalCode: 110303876
CountryCode: US
TelephoneNumber: 5165622925
FaxNumber: 5165623569
Practice Location
Address1: 1001 FRANKLIN AVE RM 110
Address2:  
City: GARDEN CITY
State: NY
PostalCode: 115302901
CountryCode: US
TelephoneNumber: 5163967846
FaxNumber:  
Other Information
ProviderEnumerationDate: 06/15/2015
LastUpdateDate: 08/16/2019
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207Q00000XMT208517PAN Allopathic & Osteopathic PhysiciansFamily Medicine 
207Q00000XMD463890PAN Allopathic & Osteopathic PhysiciansFamily Medicine 
207QS0010X300074NYY Allopathic & Osteopathic PhysiciansFamily MedicineSports Medicine

No ID Information.


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