MEDICARE: CALEB Y. CHUNG, DPM, PC

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	213EP1101X	Primary Podiatric Medicine Podiatrist	25MD00263100	NJ

General Provider Information

NPI Number	:	1871773903
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CALEB Y. CHUNG, DPM, PC

Provider Business Mailing Address
First Line	:	570 MAIN ST STE 101
Second Line	:
City	:	FORT LEE
State	:	NJ
Zip	:	07024-5058
Country	:	US
Telephone Number	:	201-363-1200
Fax Number	:	201-363-1600

Provider Business Practice Location Address
First Line	:	570 MAIN ST STE 101
Second Line	:
City	:	FORT LEE
State	:	NJ
Zip	:	07024-5058
Country	:	US
Telephone Number	:	201-363-1200
Fax Number	:	201-363-1600

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. CALEB YOUNG-JU CHUNG
Credential	:	DPM
Telephone Number	:	201-363-1200

Provider Enumeration Date	:	11/06/2007
Last Update Date	:	07/18/2022

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