Provider Demographics
NPI:1528070232
Name:MABEL M P CHENG, MD, PLLC
Entity type:Organization
Organization Name:MABEL M P CHENG, MD, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MABEL
Authorized Official - Middle Name:M P
Authorized Official - Last Name:CHENG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:518-782-7777
Mailing Address - Street 1:PO BOX 9177
Mailing Address - Street 2:
Mailing Address - City:NISKAYUNA
Mailing Address - State:NY
Mailing Address - Zip Code:12309-0177
Mailing Address - Country:US
Mailing Address - Phone:518-782-7777
Mailing Address - Fax:518-782-4913
Practice Address - Street 1:1072 TROY SCHENECTADY RD
Practice Address - Street 2:SUITE 135
Practice Address - City:LATHAM
Practice Address - State:NY
Practice Address - Zip Code:12110-1025
Practice Address - Country:US
Practice Address - Phone:518-782-7777
Practice Address - Fax:518-782-4913
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-12
Last Update Date:2007-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1690871207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYBA0521Medicare PIN