Provider Demographics
NPI:1417315854
Name:FUNG, TERENCE JASON (MS, OTR/L)
Entity Type:Individual
Prefix:MR
First Name:TERENCE
Middle Name:JASON
Last Name:FUNG
Suffix:
Gender:M
Credentials:MS, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21617 68TH AVE
Mailing Address - Street 2:
Mailing Address - City:OAKLAND GARDENS
Mailing Address - State:NY
Mailing Address - Zip Code:11364-2604
Mailing Address - Country:US
Mailing Address - Phone:646-226-5730
Mailing Address - Fax:
Practice Address - Street 1:21617 68TH AVE
Practice Address - Street 2:
Practice Address - City:OAKLAND GARDENS
Practice Address - State:NY
Practice Address - Zip Code:11364-2604
Practice Address - Country:US
Practice Address - Phone:646-226-5730
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-01-31
Last Update Date:2016-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY015854225XP0019X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0019XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPhysical Rehabilitation