Provider Demographics
NPI:1720236813
Name:CHU, PO CHENG (MD)
Entity Type:Individual
Prefix:
First Name:PO CHENG
Middle Name:
Last Name:CHU
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 190303
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11219-0303
Mailing Address - Country:US
Mailing Address - Phone:718-666-9323
Mailing Address - Fax:
Practice Address - Street 1:2315 86TH ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11214-4309
Practice Address - Country:US
Practice Address - Phone:718-333-0093
Practice Address - Fax:718-333-0073
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-03
Last Update Date:2020-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY257725174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03969248Medicaid
NY03969248Medicaid