1194801506 NPI number — MRS. PATTY LAI CHUN PA-C

Table of content: MRS. PATTY LAI CHUN PA-C (NPI 1194801506)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1194801506 NPI number — MRS. PATTY LAI CHUN PA-C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CHUN
Provider First Name:
PATTY
Provider Middle Name:
LAI
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
PA-C
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1194801506
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/27/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
727 N BROADWAY STE B4
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MASSAPEQUA
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11758-2348
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
516-799-0210
Provider Business Mailing Address Fax Number:
516-799-0247

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
727 N BROADWAY STE B4
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MASSAPEQUA
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11758-2348
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
516-799-0210
Provider Business Practice Location Address Fax Number:
516-799-0247
Provider Enumeration Date:
10/27/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363A00000X , with the licence number:  008089 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207N00000X , with the licence number: 008089-1 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)