Provider Demographics
NPI:1326104498
Name:MOON, CHEUNG
Entity Type:Individual
Prefix:DR
First Name:CHEUNG
Middle Name:
Last Name:MOON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:965 HUNTINGTON DR
Mailing Address - Street 2:
Mailing Address - City:FISHKILL
Mailing Address - State:NY
Mailing Address - Zip Code:12524-4925
Mailing Address - Country:US
Mailing Address - Phone:845-440-7154
Mailing Address - Fax:
Practice Address - Street 1:3 HATFIELD LN
Practice Address - Street 2:SUITE 1
Practice Address - City:GOSHEN
Practice Address - State:NY
Practice Address - Zip Code:10924-6731
Practice Address - Country:US
Practice Address - Phone:845-291-7480
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DC130802084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYMD110188-1OtherLICENSE NO.
NYMD110188-1OtherLICENSE NO.