MEDICARE: SARAH J. CHONG D.D.S.

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	1223G0001X	General Practice Dentistry	053388-1	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1992981831
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SARAH J. CHONG D.D.S.

Provider Business Mailing Address
First Line	:	201 BRIDGE PLZ N
Second Line	:
City	:	FORT LEE
State	:	NJ
Zip	:	07024-5911
Country	:	US
Telephone Number	:	646-271-0453
Fax Number	:

Provider Business Practice Location Address
First Line	:	241 W 30TH ST
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10001-2823
Country	:	US
Telephone Number	:	917-351-0200
Fax Number	:

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

Provider Enumeration Date	:	01/10/2008
Last Update Date	:	01/10/2008

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