Provider Demographics
NPI:1669691457
Name:CHEUCK, LANNA
Entity type:Individual
Prefix:
First Name:LANNA
Middle Name:
Last Name:CHEUCK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2300 WESTCHESTER AVE
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10462-5072
Mailing Address - Country:US
Mailing Address - Phone:718-409-8939
Mailing Address - Fax:718-409-8991
Practice Address - Street 1:2300 WESTCHESTER AVE
Practice Address - Street 2:2ND FLOOR
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10462-5072
Practice Address - Country:US
Practice Address - Phone:718-409-8939
Practice Address - Fax:718-409-8991
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-24
Last Update Date:2013-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY255847208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology