MEDICARE: MR. ERIC CHONG R.N., L.AC., M.O.M.

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	429365-1	NY
2	171100000X	Acupuncturist	001446	NY

General Provider Information

NPI Number	:	1730328345
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. ERIC CHONG R.N., L.AC., M.O.M.

Provider Business Mailing Address
First Line	:	50 FORT PL
Second Line	:	#A1B
City	:	STATEN ISLAND
State	:	NY
Zip	:	10301-2415
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	40 EXCHANGE PL
Second Line	:	3RD FL TRS STE
City	:	NEW YORK
State	:	NY
Zip	:	10005-2701
Country	:	US
Telephone Number	:	646-299-5062
Fax Number	:

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

Provider Enumeration Date	:	02/05/2009
Last Update Date	:	11/10/2014

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Directions to “ MR. ERIC CHONG R.N., L.AC., M.O.M.” Practice Location

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