Healthcare Provider Details

I. General information

NPI: 1144742552
Provider Name (Legal Business Name): SUSAN CHUNG MPH, FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/07/2017
Last Update Date: 01/29/2020
Certification Date: 01/29/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

240 E 59TH ST FL 2
NEW YORK NY
10022-1475
US

IV. Provider business mailing address

240 E 59TH ST FL 2
NEW YORK NY
10022-1475
US

V. Phone/Fax

Practice location:
  • Phone: 212-746-1500
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number722118-1
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number342648
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: