MEDICARE: MS. DINAH KRISTINE CHEONG GEONZON RN WHNP- BC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LW0102X	Women's Health Nurse Practitioner	421224	NY

General Provider Information

NPI Number	:	1306389960
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. DINAH KRISTINE CHEONG GEONZON RN WHNP- BC

Provider Business Mailing Address
First Line	:	61 HARVARD DR
Second Line	:
City	:	HARTSDALE
State	:	NY
Zip	:	10530-2006
Country	:	US
Telephone Number	:	718-579-1737
Fax Number	:

Provider Business Practice Location Address
First Line	:	2130 FORD ST
Second Line	:	1ST FLR
City	:	BROOKLYN
State	:	NY
Zip	:	11229-5140
Country	:	US
Telephone Number	:	718-676-1025
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/29/2016
Last Update Date	:	01/26/2018

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