Healthcare Provider Details

I. General information

NPI: 1386636645
Provider Name (Legal Business Name): CHUN-PENG T CHAO MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/22/2005
Last Update Date: 07/22/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19 BRADHURST AVE STE. 1400
HAWTHORNE NY
10532-2140
US

IV. Provider business mailing address

22 SAW MILL RIVER RD 2ND FLOOR
HAWTHORNE NY
10532-1533
US

V. Phone/Fax

Practice location:
  • Phone: 914-594-4835
  • Fax: 914-594-4762
Mailing address:
  • Phone: 914-594-4835
  • Fax: 914-594-4762

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0216X
TaxonomyPediatric Rheumatology Physician
License Number192592
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: