Provider Demographics
NPI:1538666524
Name:TU, CHENGCHENG
Entity Type:Individual
Prefix:
First Name:CHENGCHENG
Middle Name:
Last Name:TU
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16216 UNION TPKE STE 306
Mailing Address - Street 2:
Mailing Address - City:FRESH MEADOWS
Mailing Address - State:NY
Mailing Address - Zip Code:11366-1960
Mailing Address - Country:US
Mailing Address - Phone:718-380-7900
Mailing Address - Fax:
Practice Address - Street 1:16216 UNION TPKE STE 306
Practice Address - Street 2:
Practice Address - City:FRESH MEADOWS
Practice Address - State:NY
Practice Address - Zip Code:11366-1960
Practice Address - Country:US
Practice Address - Phone:718-380-7900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-06
Last Update Date:2022-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY007231213E00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist