Basic Information
| Provider Information | |||||||||
| NPI: | 1659563955 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | LE | ||||||||
| FirstName: | MINA | ||||||||
| MiddleName: | NGUYEN | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 419430 | ||||||||
| Address2: | |||||||||
| City: | BOSTON | ||||||||
| State: | MA | ||||||||
| PostalCode: | 022419430 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2019678221 | ||||||||
| FaxNumber: | 2014832242 | ||||||||
| Practice Location | |||||||||
| Address1: | 311 BAY AVE STE 300B | ||||||||
| Address2: | |||||||||
| City: | GLEN RIDGE | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 070281607 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9737984777 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/10/2007 | ||||||||
| LastUpdateDate: | 02/23/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 02/23/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Y00000X | NO LICENSE YET | MN | N | Allopathic & Osteopathic Physicians | Otolaryngology | 207Y00000X | 25MA10373000 | NJ | Y | Allopathic & Osteopathic Physicians | Otolaryngology |
No ID Information.