Basic Information
| Provider Information | |||||||||
| NPI: | 1972696185 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CUNNINGHAM | ||||||||
| FirstName: | CHINAZO | ||||||||
| MiddleName: | O | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 305 E 161ST ST | ||||||||
| Address2: | |||||||||
| City: | BRONX | ||||||||
| State: | NY | ||||||||
| PostalCode: | 104513535 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7185792500 | ||||||||
| FaxNumber: | 7185792599 | ||||||||
| Practice Location | |||||||||
| Address1: | 305 E 161ST ST | ||||||||
| Address2: | |||||||||
| City: | BRONX | ||||||||
| State: | NY | ||||||||
| PostalCode: | 104513535 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7185792500 | ||||||||
| FaxNumber: | 7185792599 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/02/2006 | ||||||||
| LastUpdateDate: | 04/01/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 04/01/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 204800 | NY | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207RA0401X | 204800 | NY | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Addiction Medicine |
No ID Information.