Provider Demographics
NPI:1003141573
Name:CTU MEDICAL PC
Entity Type:Organization
Organization Name:CTU MEDICAL PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:WELLMAN
Authorized Official - Middle Name:
Authorized Official - Last Name:CHEUNG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-853-2828
Mailing Address - Street 1:837 58TH ST FL 5
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11220-3662
Mailing Address - Country:US
Mailing Address - Phone:718-853-2828
Mailing Address - Fax:718-975-0040
Practice Address - Street 1:837 58TH ST FL 5TH
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11220-3662
Practice Address - Country:US
Practice Address - Phone:718-853-2828
Practice Address - Fax:718-975-0040
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-16
Last Update Date:2010-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY204223174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYA100020545Medicare PIN