Provider Demographics
NPI:1548654601
Name:CONEY, CHUNGYIKEM
Entity type:Individual
Prefix:
First Name:CHUNGYIKEM
Middle Name:
Last Name:CONEY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5600 SW 12TH ST
Mailing Address - Street 2:APT A220
Mailing Address - City:N LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33068-4092
Mailing Address - Country:US
Mailing Address - Phone:754-281-4100
Mailing Address - Fax:
Practice Address - Street 1:5600 SW 12 ST
Practice Address - Street 2:APT A220
Practice Address - City:N LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33068
Practice Address - Country:US
Practice Address - Phone:754-281-4100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-03-26
Last Update Date:2015-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246RP1900XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyPhlebotomy