Healthcare Provider Details

I. General information

NPI: 1174002646
Provider Name (Legal Business Name): HAEYOUNG CHONG
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/07/2018
Last Update Date: 08/07/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

319 S MANNING BLVD STE 202
ALBANY NY
12208-1743
US

IV. Provider business mailing address

2 CLARICE LN
COHOES NY
12047-4862
US

V. Phone/Fax

Practice location:
  • Phone: 518-435-0842
  • Fax:
Mailing address:
  • Phone: 801-915-8664
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number308868
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: