Healthcare Provider Details

I. General information

NPI: 1841950383
Provider Name (Legal Business Name): GUANJUN CHENG
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/25/2021
Last Update Date: 05/08/2024
Certification Date: 05/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14 LINCOLN AVE
YEADON PA
19050-2822
US

IV. Provider business mailing address

6136 170TH ST APT M4
FRESH MEADOWS NY
11365-1957
US

V. Phone/Fax

Practice location:
  • Phone: 610-262-7700
  • Fax: 610-626-7690
Mailing address:
  • Phone: 718-709-0940
  • Fax: 516-441-6768

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberSP024947
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: