Provider Demographics
NPI:1548219041
Name:MAUNG, MAUNG (MD)
Entity Type:Individual
Prefix:
First Name:MAUNG
Middle Name:
Last Name:MAUNG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13620 38TH AVE FL 4
Mailing Address - Street 2:SUITE CFC
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11354-4277
Mailing Address - Country:US
Mailing Address - Phone:718-461-0978
Mailing Address - Fax:718-461-0973
Practice Address - Street 1:13620 38TH AVE FL 4
Practice Address - Street 2:SUITE CFC
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11354-4277
Practice Address - Country:US
Practice Address - Phone:718-461-0978
Practice Address - Fax:718-461-0973
Is Sole Proprietor?:No
Enumeration Date:2006-05-10
Last Update Date:2013-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2002761207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01587677Medicaid
06N892Medicare ID - Type Unspecified
NY01587677Medicaid