MEDICARE: DER-CHENG TSUNG 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	2084P0800X	Psychiatry Physician	111971	NY

General Provider Information

NPI Number	:	1124232517
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DER-CHENG TSUNG M.D.

Provider Business Mailing Address
First Line	:	6 FOX HILL RD
Second Line	:
City	:	EDISON
State	:	NJ
Zip	:	08820-2824
Country	:	US
Telephone Number	:	732-548-1997
Fax Number	:	732-548-1997

Provider Business Practice Location Address
First Line	:	4609 5TH AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11220-1207
Country	:	US
Telephone Number	:	718-436-4781
Fax Number	:	732-548-1997

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

Provider Enumeration Date	:	05/09/2007
Last Update Date	:	12/03/2007

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