Provider Demographics
NPI:1891863676
Name:TZENG, SUN C (MD)
Entity Type:Individual
Prefix:
First Name:SUN
Middle Name:C
Last Name:TZENG
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 1:172 MARTIN LUTHER KING JR DR
Mailing Address - Street 2:
Mailing Address - City:JERSEY CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07305-3309
Mailing Address - Country:US
Mailing Address - Phone:201-432-8600
Mailing Address - Fax:201-261-1627
Practice Address - Street 1:172 MARTIN LUTHER KING JR DR
Practice Address - Street 2:
Practice Address - City:JERSEY CITY
Practice Address - State:NJ
Practice Address - Zip Code:07305-3309
Practice Address - Country:US
Practice Address - Phone:201-432-8600
Practice Address - Fax:201-261-1627
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA028148207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ3759105Medicaid
NJ520854Medicare ID - Type Unspecified
NJ3759105Medicaid