Provider Demographics
NPI:1982670634
Name:FUNG, SANDY M (MD)
Entity Type:Individual
Prefix:DR
First Name:SANDY
Middle Name:M
Last Name:FUNG
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 1:17 ELIZABETH ST
Mailing Address - Street 2:SUITE 509
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10013-4803
Mailing Address - Country:US
Mailing Address - Phone:212-925-5230
Mailing Address - Fax:
Practice Address - Street 1:17 ELIZABETH ST
Practice Address - Street 2:SUITE 509
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10013-4803
Practice Address - Country:US
Practice Address - Phone:212-925-5230
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-23
Last Update Date:2011-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY218860207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY33V851Medicare ID - Type Unspecified
NYH41914Medicare UPIN