Provider Demographics
NPI:1962444521
Name:EINSTEIN W. CHENG125
Entity Type:Organization
Organization Name:EINSTEIN W. CHENG125
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PA
Authorized Official - Prefix:MR
Authorized Official - First Name:EINSTEIN
Authorized Official - Middle Name:W
Authorized Official - Last Name:CHENG
Authorized Official - Suffix:
Authorized Official - Credentials:PA
Authorized Official - Phone:718-670-1572
Mailing Address - Street 1:5645 MAIN ST
Mailing Address - Street 2:RM W238
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11355-5045
Mailing Address - Country:US
Mailing Address - Phone:718-670-1572
Mailing Address - Fax:718-670-1864
Practice Address - Street 1:5645 MAIN ST
Practice Address - Street 2:RM W238
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11355-5045
Practice Address - Country:US
Practice Address - Phone:718-670-1572
Practice Address - Fax:718-670-1864
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY40071363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Single Specialty