Healthcare Provider Details

I. General information

NPI: 1205446416
Provider Name (Legal Business Name): MY HAI CHUNG FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/03/2020
Last Update Date: 08/26/2024
Certification Date: 08/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4377 BRONX BLVD
BRONX NY
10466-1397
US

IV. Provider business mailing address

6 PARK ST
ONEONTA NY
13820-2016
US

V. Phone/Fax

Practice location:
  • Phone: 718-325-0700
  • Fax:
Mailing address:
  • Phone: 607-242-7649
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number346270
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: