Provider Demographics
NPI:1033119920
Name:THUNG, SWAN N (MD)
Entity type:Individual
Prefix:
First Name:SWAN
Middle Name:N
Last Name:THUNG
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1 GUSTAVE L LEVY PL
Mailing Address - Street 2:PATHOLOGY
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10029-6500
Mailing Address - Country:US
Mailing Address - Phone:212-731-7771
Mailing Address - Fax:212-534-7491
Practice Address - Street 1:1 GUSTAVE L LEVY PL
Practice Address - Street 2:PATHOLOGY
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10029-6500
Practice Address - Country:US
Practice Address - Phone:212-241-9139
Practice Address - Fax:212-348-9412
Is Sole Proprietor?:No
Enumeration Date:2005-07-21
Last Update Date:2012-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY125321207ZI0100X, 207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
No207ZI0100XAllopathic & Osteopathic PhysiciansPathologyImmunopathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYB14493Medicare UPIN
NY43A101Medicare ID - Type Unspecified