Individual provider Active NPI

Jacky Fung

  • Medical Physician Assistant
  • Bronx, NY
National Provider Identifier
1720805088
Registry record updated Sep 26, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medical Physician AssistantTaxonomy code 363AM0700X
Practice address
1825 Eastchester Rd
Bronx, NY 10461-2301
Phone
(718) 904-2000
NPI assigned
Sep 26, 2024
Last updated
Sep 26, 2024By the provider in NPPES
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 26, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Medical Physician Assistant 363AM0700X Primary

Addresses

Primary practice location

1825 Eastchester Rd
Bronx, NY 10461-2301

Mailing address

3520 Leverich St Apt A210
Jackson Heights, NY 11372-3927
Phone (917) 239-9645

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20250327001139 NY Practitioner - Physician Assistant 9739602020 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
032933NYMDGeneral Practice Dentistry

Practice roles

OrganizationSpecialtyStatusNew patients
Montefiore Medical Center CurrentSince Jan 17, 2025 Accepting new patients
Montefiore Medical Center CurrentSince Jan 17, 2025 Accepting new patients
Montefiore Medical Center Past Accepting new patients

Locations

111 E 210th St
Bronx, NY 10467

1825 Eastchester Rd
Bronx, NY 10461
Phone (718) 904-2000

Networks

  • Healthfirst Medicare Network H5989
  • Healthfirst Medicare Network H1722
  • Healthfirst Medicare Network H9678
  • Healthfirst Medicare Network H3359

Interoperability endpoints

  • Direct secure messaging: jfung@montefioredirect.com

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1727308800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1727308800000",
    "number": "1720805088",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3520 LEVERICH ST APT A210",
            "city": "JACKSON HEIGHTS",
            "state": "NY",
            "postal_code": "113723927",
            "telephone_number": "917-239-9645"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1825 EASTCHESTER RD",
            "city": "BRONX",
            "state": "NY",
            "postal_code": "104612301",
            "telephone_number": "718-904-2000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FUNG",
        "first_name": "JACKY",
        "sole_proprietor": "NO",
        "sex": "U",
        "enumeration_date": "2024-09-26",
        "last_updated": "2024-09-26",
        "certification_date": "2024-09-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Bronx, NY

Sources for this page

Verify at the official NPI Registry.