Provider Demographics
NPI:1932859667
Name:DENG, MAX LEE (MD, MPH)
Entity Type:Individual
Prefix:
First Name:MAX
Middle Name:LEE
Last Name:DENG
Suffix:
Gender:M
Credentials:MD, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:43 NEW SCOTLAND AVENUE
Mailing Address - Street 2:DEPARTMENT OF MEDPEDS
Mailing Address - City:ALBANY
Mailing Address - State:NY
Mailing Address - Zip Code:12208-3412
Mailing Address - Country:US
Mailing Address - Phone:518-262-7585
Mailing Address - Fax:
Practice Address - Street 1:43 NEW SCOTLAND AVENUE
Practice Address - Street 2:DEPARTMENT OF MEDPEDS
Practice Address - City:ALBANY
Practice Address - State:NY
Practice Address - Zip Code:12208-3412
Practice Address - Country:US
Practice Address - Phone:518-262-7585
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-25
Last Update Date:2022-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY64587390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program