MEDICARE: DR. JEFF CHUNG M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RR0500X	Rheumatology Physician	25MA07780800	NJ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1083684088
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JEFF CHUNG M.D.

Provider Business Mailing Address
First Line	:	466 OLD HOOK RD
Second Line	:
City	:	EMERSON
State	:	NJ
Zip	:	07630-1377
Country	:	US
Telephone Number	:	201-967-8221
Fax Number	:	201-634-9647

Provider Business Practice Location Address
First Line	:	466 OLD HOOK RD
Second Line	:
City	:	EMERSON
State	:	NJ
Zip	:	07630-1377
Country	:	US
Telephone Number	:	201-967-8221
Fax Number	:	201-634-9647

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/24/2006
Last Update Date	:	12/11/2012

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