Healthcare Provider Details

I. General information

NPI: 1093150153
Provider Name (Legal Business Name): ALLEN FUNG DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/02/2013
Last Update Date: 12/12/2019
Certification Date: 12/12/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

827 FOREST AVE
STATEN ISLAND NY
10310-2410
US

IV. Provider business mailing address

827 FOREST AVE
STATEN ISLAND NY
10310-2410
US

V. Phone/Fax

Practice location:
  • Phone: 347-977-4676
  • Fax:
Mailing address:
  • Phone: 718-981-5098
  • Fax: 718-981-6792

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code213ES0000X
TaxonomySports Medicine Podiatrist
License Number006673
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code213ER0200X
TaxonomyRadiology Podiatrist
License Number006673
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number006673
License Number StateNY
# 4
Primary TaxonomyY
Taxonomy Code213EP1101X
TaxonomyPrimary Podiatric Medicine Podiatrist
License Number006673
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: