Provider Demographics
NPI:1275618266
Name:CHOU, FONG MEI (MD)
Entity Type:Individual
Prefix:DR
First Name:FONG
Middle Name:MEI
Last Name:CHOU
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 1:200 RIVERSIDE BLVD
Mailing Address - Street 2:APT 24A
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10069-0901
Mailing Address - Country:US
Mailing Address - Phone:917-441-6965
Mailing Address - Fax:
Practice Address - Street 1:199 N MIDDLETOWN RD
Practice Address - Street 2:
Practice Address - City:NANUET
Practice Address - State:NY
Practice Address - Zip Code:10954-1317
Practice Address - Country:US
Practice Address - Phone:845-623-3904
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-26
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY141605-1207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01477563Medicaid
NY50K743Medicare ID - Type UnspecifiedEMPIRE MEDICARE SERVICES
NY01477563Medicaid