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General NPI Number Information
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NPI Number | 1548721848
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Entity Type | Individual
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Provider Name | JONATHAN TIMOTHY FUNG DPM
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Gender | Male
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Dates
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Enumeration Date | 03/28/2019
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Last Update Date | 10/05/2023
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Provider Practice Location Address
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Address Line | 350 BLOOMFIELD AVE STE 5
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City | BLOOMFIELD
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State | NJ
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Zip | 07003-4852
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Country | US
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Telephone | 973-429-1300
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Fax | 973-429-0037
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Provider Business Mailing Address
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Address Line | 784 HARVARD PL
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City | CLIFFSIDE PARK
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State | NJ
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Zip | 07010-2103
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Country | US
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Telephone | 714-478-1990
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213ES0103X
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Taxonomy Name | Foot & Ankle Surgery Podiatrist
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License Number | 25MD0037900
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License Number State | NJ
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