Provider Demographics
NPI:1730117904
Name:CHENG, JENNIFER (MD)
Entity Type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:
Last Name:CHENG
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:552 DARWIN BLVD
Mailing Address - Street 2:
Mailing Address - City:EDISON
Mailing Address - State:NJ
Mailing Address - Zip Code:08820-2342
Mailing Address - Country:US
Mailing Address - Phone:732-632-1781
Mailing Address - Fax:
Practice Address - Street 1:863 50TH ST
Practice Address - Street 2:UNIT M5
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11220-6877
Practice Address - Country:US
Practice Address - Phone:718-686-8880
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-28
Last Update Date:2011-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY213865208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYH31319Medicare UPIN