Provider Demographics
NPI:1730328345
Name:CHONG, ERIC (RN, LAC, MOM)
Entity type:Individual
Prefix:MR
First Name:ERIC
Middle Name:
Last Name:CHONG
Suffix:
Gender:M
Credentials:RN, LAC, MOM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:50 FORT PL
Mailing Address - Street 2:#A1B
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10301-2415
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:40 EXCHANGE PL
Practice Address - Street 2:3RD FL TRS STE
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10005-2701
Practice Address - Country:US
Practice Address - Phone:646-299-5062
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-05
Last Update Date:2014-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY429365-1163W00000X
NY001446171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No171100000XOther Service ProvidersAcupuncturist