MEDICARE: ERIC CHENG MD

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	207Q00000X	Family Medicine Physician	152282	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	93A131	OTHER	NY	BLUE CROSS BLUE SHIELD

General Provider Information

NPI Number	:	1417935180
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ERIC CHENG MD

Provider Business Mailing Address
First Line	:	3309 CHURCH AVE
Second Line	:	SECOND FLOOR
City	:	BROOKLYN
State	:	NY
Zip	:	11203-2711
Country	:	US
Telephone Number	:	718-856-3100
Fax Number	:

Provider Business Practice Location Address
First Line	:	3309 CHURCH AVE
Second Line	:	SECOND FLOOR
City	:	BROOKLYN
State	:	NY
Zip	:	11203-2711
Country	:	US
Telephone Number	:	718-856-3100
Fax Number	:

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

Provider Enumeration Date	:	01/04/2006
Last Update Date	:	03/21/2008

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