Individual provider Active NPI

Thao Nguyen, NPP

  • Psychiatric/Mental Health Nurse Practitioner
  • Coram, NY
National Provider Identifier
1033665864
Registry record updated Oct 27, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X
License
F401940-1 Issued in NY
Practice address
12 Fairwood LN
Coram, NY 11727-3336
Phone
(631) 318-4004
Fax
(631) 318-6443
NPI assigned
Aug 31, 2016
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Oct 27, 2023

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatric/Mental Health Nurse Practitioner 363LP0808X F401940-1 NY Primary

Addresses

Primary practice location

12 Fairwood LN
Coram, NY 11727-3336

Mailing address

1070 Middle Country Rd Ste 7-271
Selden, NY 11784-2580
Phone (516) 398-6691

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
F401940-1NYMDPsychiatric/Mental Health Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Thao Nguyen Nurse Practitioner in Psychiatry PC Psychiatric/Mental Health CurrentSince May 1, 2022 Accepting new patients

Locations

165 N Village Ave
Ste 216
Rockville Ctr, NY 11570
Phone (516) 665-9669

761 Middle Country Rd
Ste 1
Selden, NY 11784

1070 Middle Country Rd
Ste 7271
Selden, NY 11784

400 Montauk Hwy
West Islip, NY 11795
Phone (631) 321-7107

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1472601600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1698364800000",
    "number": "1033665864",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1070 MIDDLE COUNTRY RD STE 7-271",
            "city": "SELDEN",
            "state": "NY",
            "postal_code": "117842580",
            "telephone_number": "516-398-6691",
            "fax_number": "631-318-6443"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12 FAIRWOOD LN",
            "city": "CORAM",
            "state": "NY",
            "postal_code": "117273336",
            "telephone_number": "631-318-4004",
            "fax_number": "631-318-6443"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NGUYEN",
        "first_name": "THAO",
        "credential": "NPP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2016-08-31",
        "last_updated": "2023-10-27",
        "certification_date": "2023-10-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "NY",
            "license": "F401940-1",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Coram, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 27, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.