MEDICARE: TERESA MIN-JUNG O 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	207Y00000X	Otolaryngology Physician	P39757	NY

General Provider Information

NPI Number	:	1447308218
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TERESA MIN-JUNG O M.D.

Provider Business Mailing Address
First Line	:	525 EAST 72ND STREET
Second Line	:	APT 25F
City	:	NEW YORK
State	:	NY
Zip	:	10021-9601
Country	:	US
Telephone Number	:	646-825-1893
Fax Number	:	212-249-1214

Provider Business Practice Location Address
First Line	:	525 E 72ND ST
Second Line	:	APT 25F
City	:	NEW YORK
State	:	NY
Zip	:	10021-9601
Country	:	US
Telephone Number	:	646-825-1893
Fax Number	:	212-249-1214

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

Provider Enumeration Date	:	01/08/2007
Last Update Date	:	08/09/2007

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