Provider Demographics
NPI:1104281419
Name:NG, NORMAN (LAC)
Entity type:Individual
Prefix:MR
First Name:NORMAN
Middle Name:
Last Name:NG
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:515 MOUNTAIN BLVD
Mailing Address - Street 2:
Mailing Address - City:WATCHUNG
Mailing Address - State:NJ
Mailing Address - Zip Code:07069-6248
Mailing Address - Country:US
Mailing Address - Phone:908-251-5216
Mailing Address - Fax:908-251-5216
Practice Address - Street 1:515 MOUNTAIN BLVD
Practice Address - Street 2:
Practice Address - City:WATCHUNG
Practice Address - State:NJ
Practice Address - Zip Code:07069-6248
Practice Address - Country:US
Practice Address - Phone:908-251-5216
Practice Address - Fax:908-251-5216
Is Sole Proprietor?:Yes
Enumeration Date:2015-12-31
Last Update Date:2015-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MZ00116600171100000X
NY005666171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist