Healthcare Provider Details

I. General information

NPI: 1063783058
Provider Name (Legal Business Name): JANICE M CHEUNG PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/23/2012
Last Update Date: 08/19/2026
Certification Date: 08/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

169 MADISON AVE STE 15370
NEW YORK NY
10016-5101
US

IV. Provider business mailing address

169 MADISON AVE STE 15370
NEW YORK NY
10016-5101
US

V. Phone/Fax

Practice location:
  • Phone: 844-484-7362
  • Fax:
Mailing address:
  • Phone: 844-484-7362
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number13467
License Number StateMN
# 2
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number015294
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number50.007673RX
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: