Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213EP1101X | Primary Podiatric Medicine | 006673 | NY |
N | 111NR0200X | Radiology | 006673 | NY |
N | 213ER0200X | Radiology | 006673 | NY |
N | 2081S0010X | Sports Medicine | 006673 | NY |
N | 213ES0000X | Sports Medicine | 006673 | NY |
N | 213ES0103X | Foot & Ankle Surgery | 006673 | NY |
NPI | 1093150153 |
---|---|
Provider Name | Dr. Allen Fung |
First Address | Staten Island, NY 10310-2410 |
Second Address | Staten Island, NY 10310-2410 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/05/2013 |
Last Update Date | 12/12/2019 |