Provider Demographics
NPI:1295727808
Name:WHANG, EUGENE J (MD)
Entity type:Individual
Prefix:
First Name:EUGENE
Middle Name:J
Last Name:WHANG
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:PO BOX 682
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10465-0620
Mailing Address - Country:US
Mailing Address - Phone:718-792-4700
Mailing Address - Fax:718-828-1898
Practice Address - Street 1:3620 E TREMONT AVE
Practice Address - Street 2:2ND FLOOR
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10465-2022
Practice Address - Country:US
Practice Address - Phone:718-792-4700
Practice Address - Fax:718-828-1898
Is Sole Proprietor?:No
Enumeration Date:2005-08-19
Last Update Date:2021-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY207206207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01990481Medicaid
G85089Medicare UPIN
NY094311Medicare ID - Type Unspecified