=====================================================
General NPI Number Information
=====================================================
NPI Number | 1619214285
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | PHOENIX C FUNG M.D.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/15/2013
-----------------------------------------------------
Last Update Date | 09/16/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1307 FEDERAL ST STE B100
-----------------------------------------------------
City | PITTSBURGH
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 15212
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 412-359-8900
-----------------------------------------------------
Fax | 412-359-8977
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 331 NEWMAN SPRINGS ROAD BLDG. 2, SUITE 220
-----------------------------------------------------
City | RED BANK
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07701
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 732-807-0877
-----------------------------------------------------
Fax | 201-751-1680
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207RG0100X
-----------------------------------------------------
Taxonomy Name | Gastroenterology Physician
-----------------------------------------------------
License Number | 25MA09289100
-----------------------------------------------------
License Number State | NJ
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 207RG0100X
-----------------------------------------------------
Taxonomy Name | Gastroenterology Physician
-----------------------------------------------------
License Number | MD460608
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------