Healthcare Provider Details

I. General information

NPI: 1245393974
Provider Name (Legal Business Name): CHENG OW M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/17/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

37 N FULLERTON AVE
MONTCLAIR NJ
07042-3426
US

IV. Provider business mailing address

1466 WOODACRES DR
MOUNTAINSIDE NJ
07092-1732
US

V. Phone/Fax

Practice location:
  • Phone: 973-509-1818
  • Fax:
Mailing address:
  • Phone: 908-654-6367
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number25MA05667000
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: