Basic Information
| Provider Information | |||||||||
| NPI: | 1538386537 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SZE FONG NG MD PC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4 TIMBERCREST LANE | ||||||||
| Address2: | |||||||||
| City: | SOUTH SETAUKET | ||||||||
| State: | NY | ||||||||
| PostalCode: | 117201222 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5165616119 | ||||||||
| FaxNumber: | 5165942623 | ||||||||
| Practice Location | |||||||||
| Address1: | 2000 N VILLAGE AVE STE 314 | ||||||||
| Address2: | |||||||||
| City: | ROCKVILLE CENTRE | ||||||||
| State: | NY | ||||||||
| PostalCode: | 115701001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5165616119 | ||||||||
| FaxNumber: | 5165942623 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/19/2007 | ||||||||
| LastUpdateDate: | 01/28/2008 | ||||||||
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| AuthorizedOfficialLastName: | NG | ||||||||
| AuthorizedOfficialFirstName: | SZE FONG | ||||||||
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| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 5165616119 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 212900 | NY | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 02009245 | 05 | NY | MEDICAID |