Individual
DAPENG FAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
355 BARD AVE, STATEN ISLAND, NY 10310-1664
(718) 818-2843
(718) 818-4709
Mailing address
1 BEACH 105TH ST, APT. 1X, ROCKAWAY PARK, NY 11694-2695
(201) 804-2800
(201) 804-8883
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
253526
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
253526
THE UNIVERSITY OF THE STATE OF NEW YORK -EDUCATION DEPARTMENT
NY
01
—
MD436206
LICENSE
PA
Enumeration date
02/17/2009
Last updated
06/24/2009
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