Healthcare Provider Details

I. General information

NPI: 1215330238
Provider Name (Legal Business Name): JENNIFER SUNG PHARM.D
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/04/2014
Last Update Date: 10/04/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

120 E 34TH ST
NEW YORK NY
10016-4609
US

IV. Provider business mailing address

15034 58TH RD
FLUSHING NY
11355-5420
US

V. Phone/Fax

Practice location:
  • Phone: 212-481-6606
  • Fax:
Mailing address:
  • Phone: 917-650-8566
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835G0303X
TaxonomyGeriatric Pharmacist
License Number059849
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: