Basic Information
Provider Information
NPI: 1184384091
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: CHEUNG
FirstName: WILFRED
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential: DPT, PT
OtherOrganizationName:  
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OtherCredential:  
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Mailing Information
Address1: 31 E 32ND ST FL 4
Address2:  
City: NEW YORK
State: NY
PostalCode: 100165595
CountryCode: US
TelephoneNumber: 2127592282
FaxNumber: 2123792123
Practice Location
Address1: 630 3RD AVE
Address2:  
City: NEW YORK
State: NY
PostalCode: 100176705
CountryCode: US
TelephoneNumber: 6468292290
FaxNumber: 2122989896
Other Information
ProviderEnumerationDate: 12/20/2021
LastUpdateDate: 12/20/2021
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
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IsSoleProprietor: N
IsOrganizationSubpart:  
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AuthorizedOfficialCredential:  
NPICertificationDate: 12/20/2021

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
225100000X048090NYY Respiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist 

No ID Information.


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