1962440164 NPI number — DR. CALEB YOUNG-JU CHUNG DPM

Table of content: DR. CALEB YOUNG-JU CHUNG DPM (NPI 1962440164)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1962440164 NPI number — DR. CALEB YOUNG-JU CHUNG DPM

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CHUNG
Provider First Name:
CALEB
Provider Middle Name:
YOUNG-JU
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DPM
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1962440164
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/15/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
570 MAIN ST STE 101
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FORT LEE
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
07024-5058
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
201-363-1200
Provider Business Mailing Address Fax Number:
201-363-1600

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
570 MAIN ST STE 101
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FORT LEE
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07024-5058
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
201-363-1200
Provider Business Practice Location Address Fax Number:
201-363-1600
Provider Enumeration Date:
06/02/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 213EP1101X , with the licence number:  25MD00263100 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 213ER0200X , with the licence number: 25MD00263100 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 213ES0131X , with the licence number: 25MD00263100 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 213E00000X , with the licence number: 25MD00263100 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1953226 . This is a "FIRST HEALTH" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 38688 . This is a "MASTERCARE" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 2289032 . This is a "UNITEDHEALTH PLAN" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 8891202002 . This is a "CIGNA" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: PG6032 . This is a "WELL CHOICE" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 1147720 . This is a "HORIZON NJ HEALTH" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 1K8521 . This is a "HEALTHNET" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 2106180000 . This is a "AMERIHEALTH" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 33046 . This is a "UNIVERSITY HEALTH PLAN" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 967806 . This is a "ONE HEALTH PLAN" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 51508 . This is a "AMERIGROUP" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 85344 . This is a "OPERATING ENG LOCAL 825" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 8569207 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".
  • Identifier: P2525266 . This is a "OXFORD" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".




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