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General NPI Number Information
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NPI Number | 1942411798
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Entity Type | Organization
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Legal Business Name | SUSIE CHUNG MD PC
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Dates
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Enumeration Date | 05/24/2007
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Last Update Date | 10/19/2012
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Provider Practice Location Address
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Address Line | 139 CENTRE ST. SUITE 320
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City | NEW YORK
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State | NY
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Zip | 10013-3100
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Country | US
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Telephone | 212-334-1207
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 1418
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City | NEW YORK
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State | NY
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Zip | 10156-1418
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Country | US
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Telephone | 347-392-7474
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | SUSIE CHUNG
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Credential | M.D.
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Telephone | 347-392-7474
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RN0300X
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Taxonomy Name | Nephrology Physician
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License Number | 211617
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License Number State | NY
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