Healthcare Provider Details

I. General information

NPI: 1124099247
Provider Name (Legal Business Name): ROGELIO CHENG CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/27/2006
Last Update Date: 03/06/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

99 BEAUVOIR AVE
SUMMIT NJ
07901-3533
US

IV. Provider business mailing address

PO BOX 48078
NEWARK NJ
07101-4878
US

V. Phone/Fax

Practice location:
  • Phone: 908-598-1500
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number06629900
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: