Provider Demographics
NPI:1083167902
Name:CHUNG, KAREN (FNP-BC)
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:
Last Name:CHUNG
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:298 MULBERRY ST
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10012-3331
Mailing Address - Country:US
Mailing Address - Phone:866-389-2727
Mailing Address - Fax:
Practice Address - Street 1:298 MULBERRY ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10012-3331
Practice Address - Country:US
Practice Address - Phone:866-389-2727
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-07-27
Last Update Date:2024-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY341167363LF0000X
NJ26NR14493400363LF0000X
NJ26NJ00778800363LF0000X
NYNY341167363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00695941Medicaid
NYG100000410Medicare Oscar/Certification
NY00695941Medicaid
WI331952Medicare Oscar/Certification
WI331978Medicare Oscar/Certification
WI331058Medicare Oscar/Certification
WI331009Medicare Oscar/Certification
WI331943Medicare Oscar/Certification
WI331947Medicare Oscar/Certification
WI331043Medicare Oscar/Certification
WI331944Medicare Oscar/Certification
WI331954Medicare Oscar/Certification
WI331946Medicare Oscar/Certification
WI331945Medicare Oscar/Certification