MEDICARE: DR. ERIC K FUNG MD

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	231535	NY

General Provider Information

NPI Number	:	1588662555
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ERIC K FUNG MD

Provider Business Mailing Address
First Line	:	3906 EAST GENESEE STREET
Second Line	:
City	:	DEWITT
State	:	NY
Zip	:	13214-1934
Country	:	US
Telephone Number	:	315-251-1093
Fax Number	:	315-251-1571

Provider Business Practice Location Address
First Line	:	3906 EAST GENESEE STREET
Second Line	:
City	:	DEWITT
State	:	NY
Zip	:	13214-1934
Country	:	US
Telephone Number	:	315-251-1093
Fax Number	:	315-251-1571

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

Provider Enumeration Date	:	07/13/2005
Last Update Date	:	04/23/2008

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