MEDICARE: CHANA UNGER CPNP

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	163W00000X	Registered Nurse	674085-1	NY
2	163W00000X	Registered Nurse	26NR18583000	NJ
3	363LP0200X	Pediatric Nurse Practitioner	382518	NY
4	363LP0200X	Pediatric Nurse Practitioner	26NJ00831300	NJ

General Provider Information

NPI Number	:	1366858383
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHANA UNGER CPNP

Provider Business Mailing Address
First Line	:	3206 ROUTE 9W
Second Line	:
City	:	NEW WINDSOR
State	:	NY
Zip	:	12553-6756
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3206 ROUTE 9W
Second Line	:
City	:	NEW WINDSOR
State	:	NY
Zip	:	12553-6756
Country	:	US
Telephone Number	:	845-561-5227
Fax Number	:

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

Provider Enumeration Date	:	07/10/2014
Last Update Date	:	07/22/2019

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