Provider Demographics
NPI:1043387608
Name:TUNG, MING C (DPM)
Entity Type:Individual
Prefix:MR
First Name:MING
Middle Name:C
Last Name:TUNG
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:60 MITCHELL AVE
Mailing Address - Street 2:
Mailing Address - City:E BRUNSWICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08816-1236
Mailing Address - Country:US
Mailing Address - Phone:732-828-5195
Mailing Address - Fax:
Practice Address - Street 1:8 BALDWIN AVE
Practice Address - Street 2:
Practice Address - City:JERSEY CITY
Practice Address - State:NJ
Practice Address - Zip Code:07306
Practice Address - Country:US
Practice Address - Phone:201-435-3100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MD000123700213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ7074204Medicaid
C54339Medicare UPIN
NJ7074204Medicaid