Provider Demographics
NPI:1043382112
Name:FUNG, PAULINE A
Entity Type:Individual
Prefix:
First Name:PAULINE
Middle Name:A
Last Name:FUNG
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:PAULINE
Other - Middle Name:A
Other - Last Name:SAMUELS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:AS , BS
Mailing Address - Street 1:3500 SUNRISE HWY
Mailing Address - Street 2:BUILDING 300
Mailing Address - City:GREAT RIVER
Mailing Address - State:NY
Mailing Address - Zip Code:11739-1001
Mailing Address - Country:US
Mailing Address - Phone:631-854-0168
Mailing Address - Fax:631-854-0176
Practice Address - Street 1:3500 SUNRISE HWY
Practice Address - Street 2:BUILDING 300
Practice Address - City:GREAT RIVER
Practice Address - State:NY
Practice Address - Zip Code:11739-1001
Practice Address - Country:US
Practice Address - Phone:631-854-0168
Practice Address - Fax:631-854-0176
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-14
Last Update Date:2014-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator