Provider Demographics
NPI:1013174499
Name:CHENG, TINA Q (DO)
Entity Type:Individual
Prefix:
First Name:TINA
Middle Name:Q
Last Name:CHENG
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:7901 BROADWAY
Mailing Address - Street 2:SUITE A1-18
Mailing Address - City:ELMHURST
Mailing Address - State:NY
Mailing Address - Zip Code:11373-1329
Mailing Address - Country:US
Mailing Address - Phone:718-334-1991
Mailing Address - Fax:718-334-1971
Practice Address - Street 1:7901 BROADWAY
Practice Address - Street 2:SUITE A1-18
Practice Address - City:ELMHURST
Practice Address - State:NY
Practice Address - Zip Code:11373-1329
Practice Address - Country:US
Practice Address - Phone:718-334-1991
Practice Address - Fax:718-334-1971
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-22
Last Update Date:2013-07-15
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY249865208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics