Provider Demographics
NPI:1386636645
Name:CHAO, CHUN-PENG T (MD)
Entity Type:Individual
Prefix:
First Name:CHUN-PENG
Middle Name:T
Last Name:CHAO
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:22 SAW MILL RIVER RD
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:HAWTHORNE
Mailing Address - State:NY
Mailing Address - Zip Code:10532-1533
Mailing Address - Country:US
Mailing Address - Phone:914-594-4835
Mailing Address - Fax:914-594-4762
Practice Address - Street 1:19 BRADHURST AVE
Practice Address - Street 2:STE. 1400
Practice Address - City:HAWTHORNE
Practice Address - State:NY
Practice Address - Zip Code:10532-2140
Practice Address - Country:US
Practice Address - Phone:914-594-4835
Practice Address - Fax:914-594-4762
Is Sole Proprietor?:No
Enumeration Date:2005-08-22
Last Update Date:2013-07-22
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Provider Licenses
StateLicense IDTaxonomies
NY1925922080P0216X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0216XAllopathic & Osteopathic PhysiciansPediatricsPediatric Rheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01465338Medicaid
NY91H74EA201Medicare PIN
NY91H74EA202Medicare PIN