Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213E00000X | Podiatrist | 25MD000123700 | NJ |
Y | 222Z00000X | Podiatrist | 25MD000123700 | NJ |
NPI | 1043387608 |
---|---|
Provider Name | Mr. Ming C Tung |
First Address | E Brunswick, NJ 08816-1236 |
Second Address | Jersey City, NJ 07306 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/11/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
7074204 | (05) | NJ |
C54339 | (02) |