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General NPI Number Information
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NPI Number | 1992254205
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Entity Type | Organization
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Legal Business Name | TRACY LI CHEUNG DDS MS PLLC
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Dates
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Enumeration Date | 09/27/2016
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Last Update Date | 01/10/2017
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Provider Practice Location Address
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Address Line | 449 N STATE RD STE 101
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City | BRIARCLIFF MANOR
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State | NY
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Zip | 10510-1478
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Country | US
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Telephone | 914-923-5089
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Fax | 888-972-4796
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Provider Business Mailing Address
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Address Line | 449 N STATE RD STE 101
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City | BRIARCLIFF MANOR
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State | NY
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Zip | 10510-1478
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Country | US
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Telephone | 914-923-5089
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Fax | 888-972-4796
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Authorized Official
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Title or Position | OWNER
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Name | DR. TRACY CHEUNG
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Credential | DDS MS
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Telephone | 914-923-5089
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number | 057255
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License Number State | NY
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