Healthcare Provider Details

I. General information

NPI: 1104825124
Provider Name (Legal Business Name): SERINA T CHUNG M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/20/2005
Last Update Date: 11/06/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1157 BROADWAY
HEWLETT NY
11557-2321
US

IV. Provider business mailing address

1157 BROADWAY
HEWLETT NY
11557-2321
US

V. Phone/Fax

Practice location:
  • Phone: 516-295-4481
  • Fax: 516-295-4809
Mailing address:
  • Phone: 516-295-4481
  • Fax: 516-295-4809

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License Number210666
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: