Provider Demographics
NPI:1023797370
Name:CHUNG, MARLON PAUL
Entity type:Individual
Prefix:
First Name:MARLON
Middle Name:PAUL
Last Name:CHUNG
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 HACKENSACK HEIGHTS RD
Mailing Address - Street 2:
Mailing Address - City:WAPPINGERS FALLS
Mailing Address - State:NY
Mailing Address - Zip Code:12590-6113
Mailing Address - Country:US
Mailing Address - Phone:845-784-8964
Mailing Address - Fax:
Practice Address - Street 1:2 HACKENSACK HEIGHTS RD
Practice Address - Street 2:
Practice Address - City:WAPPINGERS FALLS
Practice Address - State:NY
Practice Address - Zip Code:12590-6113
Practice Address - Country:US
Practice Address - Phone:845-784-8964
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-13
Last Update Date:2023-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide