Provider Demographics
NPI:1245393974
Name:OW, CHENG (MD)
Entity Type:Individual
Prefix:DR
First Name:CHENG
Middle Name:
Last Name:OW
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1466 WOODACRES DR
Mailing Address - Street 2:
Mailing Address - City:MOUNTAINSIDE
Mailing Address - State:NJ
Mailing Address - Zip Code:07092-1732
Mailing Address - Country:US
Mailing Address - Phone:908-654-6367
Mailing Address - Fax:
Practice Address - Street 1:37 N FULLERTON AVE
Practice Address - Street 2:
Practice Address - City:MONTCLAIR
Practice Address - State:NJ
Practice Address - Zip Code:07042-3426
Practice Address - Country:US
Practice Address - Phone:973-509-1818
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA056670002085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJF41743Medicare UPIN