Provider Demographics
NPI:1124232517
Name:TSUNG, DER-CHENG (MD)
Entity Type:Individual
Prefix:
First Name:DER-CHENG
Middle Name:
Last Name:TSUNG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 FOX HILL RD
Mailing Address - Street 2:
Mailing Address - City:EDISON
Mailing Address - State:NJ
Mailing Address - Zip Code:08820-2824
Mailing Address - Country:US
Mailing Address - Phone:732-548-1997
Mailing Address - Fax:732-548-1997
Practice Address - Street 1:4609 5TH AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11220-1207
Practice Address - Country:US
Practice Address - Phone:718-436-4781
Practice Address - Fax:732-548-1997
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-09
Last Update Date:2007-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1119712084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYB77970Medicare UPIN
NY575532Medicare ID - Type UnspecifiedM.D.