Provider Demographics
NPI:1033572110
Name:FUNG, DEBORAH (MD)
Entity Type:Individual
Prefix:DR
First Name:DEBORAH
Middle Name:
Last Name:FUNG
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MS
Other - First Name:DEBORAH
Other - Middle Name:
Other - Last Name:MOON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:GA YOUNG MOON
Mailing Address - Street 1:156 WILLIAM ST FL 6
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10038-5358
Mailing Address - Country:US
Mailing Address - Phone:646-962-5665
Mailing Address - Fax:646-962-5687
Practice Address - Street 1:156 WILLIAM ST FL 6
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10038-5358
Practice Address - Country:US
Practice Address - Phone:646-962-5665
Practice Address - Fax:646-962-5687
Is Sole Proprietor?:No
Enumeration Date:2016-04-05
Last Update Date:2019-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
NY290536207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program