Healthcare Provider Details

I. General information

NPI: 1386164689
Provider Name (Legal Business Name): CHEON TONGE MSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/27/2017
Last Update Date: 07/21/2022
Certification Date: 02/04/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

307 W. 38TH STREET SUITE 817
NEW YORK NY
10018
US

IV. Provider business mailing address

307 W 38TH ST RM 817
NEW YORK NY
10018-3541
US

V. Phone/Fax

Practice location:
  • Phone: 212-695-4564
  • Fax: 212-695-4561
Mailing address:
  • Phone: 212-695-4564
  • Fax: 212-695-4561

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: