Provider Demographics
NPI:1659465896
Name:FENG, DAVID H (MD)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:H
Last Name:FENG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1580 LAKEWOOD RD
Mailing Address - Street 2:SUITE 16B
Mailing Address - City:TOMS RIVER
Mailing Address - State:NJ
Mailing Address - Zip Code:08755-3287
Mailing Address - Country:US
Mailing Address - Phone:775-636-3780
Mailing Address - Fax:732-420-5500
Practice Address - Street 1:200 TILTON RD
Practice Address - Street 2:UNIT G-5
Practice Address - City:NORTHFIELD
Practice Address - State:NJ
Practice Address - Zip Code:08225-1270
Practice Address - Country:US
Practice Address - Phone:800-730-5347
Practice Address - Fax:609-484-0894
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2014-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA07584900174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0027561Medicaid
NJH94742Medicare UPIN
NJ0027561Medicaid