Provider Demographics
NPI:1720717515
Name:FORBES-CHUNG, JEAN E
Entity type:Individual
Prefix:
First Name:JEAN
Middle Name:E
Last Name:FORBES-CHUNG
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:552 LIBERTY ST
Mailing Address - Street 2:
Mailing Address - City:UNIONDALE
Mailing Address - State:NY
Mailing Address - Zip Code:11553-2316
Mailing Address - Country:US
Mailing Address - Phone:516-770-6250
Mailing Address - Fax:
Practice Address - Street 1:552 LIBERTY ST
Practice Address - Street 2:
Practice Address - City:UNIONDALE
Practice Address - State:NY
Practice Address - Zip Code:11553-2316
Practice Address - Country:US
Practice Address - Phone:516-770-6250
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-07
Last Update Date:2022-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY545320163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse