Provider Demographics
NPI:1104022888
Name:NEW YORK ENT PHYSICIAN PC
Entity Type:Organization
Organization Name:NEW YORK ENT PHYSICIAN PC
Other - Org Name:DR. ANDREW T CHENG
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:T
Authorized Official - Last Name:CHENG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:212-925-3569
Mailing Address - Street 1:110 LAFAYETTE ST
Mailing Address - Street 2:SUITE 501
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10013-4116
Mailing Address - Country:US
Mailing Address - Phone:212-925-3569
Mailing Address - Fax:212-966-3465
Practice Address - Street 1:110 LAFAYETTE ST
Practice Address - Street 2:SUITE 501
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10013-4116
Practice Address - Country:US
Practice Address - Phone:212-925-3569
Practice Address - Fax:212-966-3465
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYNYS 165672261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00945639Medicaid
NY00945639Medicaid
66D571Medicare ID - Type Unspecified