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NPI Code Detail

MEDICARE: DR. COLIN DAVID CHA FONG MD MBA

MEDICARE: DR. COLIN DAVID CHA FONG MD MBA
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
1207R00000XInternal Medicine Physician254515NY

General Provider Information

NPI Number : 1477712230
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. COLIN DAVID CHA FONG MD MBA
Provider Business Mailing Address
First Line : 1400 PELHAM PARKWAY SOUTH
Second Line : BLDG 1, ROOM 3N01E
City : BRONX
State : NY
Zip : 10461
Country : US
Telephone Number : 718-918-7463
Fax Number :
Provider Business Practice Location Address
First Line : 1400 PELHAM PKWY S
Second Line :
City : BRONX
State : NY
Zip : 10461-1197
Country : US
Telephone Number : 718-918-7463
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/06/2008
Last Update Date : 03/01/2019

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