Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RR0500X | Rheumatology | 210666 | NY |
NPI | 1104825124 |
---|---|
Provider Name | Dr. Serina T Chung |
First Address | Hewlett, NY 11557-2321 |
Second Address | Hewlett, NY 11557-2321 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/07/2005 |
Last Update Date | 06/11/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
02086666 | (05) | NY |
H16234 | (02) | NY |