Healthcare Provider Details

I. General information

NPI: 1285656124
Provider Name (Legal Business Name): KAREN FUNG DANTE M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KAREN L FUNG M.D.

II. Dates (important events)

Enumeration Date: 07/23/2006
Last Update Date: 11/28/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

73 S MAIN ST
MEDFORD NJ
08055-2430
US

IV. Provider business mailing address

360 STATION AVE
HADDONFIELD NJ
08033-3721
US

V. Phone/Fax

Practice location:
  • Phone: 609-654-6140
  • Fax:
Mailing address:
  • Phone: 856-795-6627
  • Fax: 856-795-6987

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberMA53095
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberMD036852E
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: