Basic Information
| Provider Information | |||||||||
| NPI: | 1881874741 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CHONG | ||||||||
| FirstName: | ANGELA | ||||||||
| MiddleName: | UN | ||||||||
| NamePrefix: | MS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | PA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4401 FRANCIS LEWIS BLVD | ||||||||
| Address2: | STE L3A | ||||||||
| City: | BAYSIDE | ||||||||
| State: | NY | ||||||||
| PostalCode: | 113613028 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7184233355 | ||||||||
| FaxNumber: | 7184233721 | ||||||||
| Practice Location | |||||||||
| Address1: | 4401 FRANCIS LEWIS BLVD | ||||||||
| Address2: | STE L3A | ||||||||
| City: | BAYSIDE | ||||||||
| State: | NY | ||||||||
| PostalCode: | 113613028 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7184233355 | ||||||||
| FaxNumber: | 7184233721 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/08/2007 | ||||||||
| LastUpdateDate: | 03/09/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 03/09/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363A00000X | 0110002214 | VA | N | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | 363AM0700X | 009183-1 | NY | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Medical |
No ID Information.