Healthcare Provider Details

I. General information

NPI: 1659301802
Provider Name (Legal Business Name): TIMOTHY CHEUNG
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/04/2006
Last Update Date: 10/03/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9017 24TH RD
EAST ELMHURST NY
11369-1110
US

IV. Provider business mailing address

9017 24TH RD
EAST ELMHURST NY
11369-1110
US

V. Phone/Fax

Practice location:
  • Phone: 718-839-3466
  • Fax:
Mailing address:
  • Phone: 718-839-3466
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number196209
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: