1588669469 NPI number — DR. TIMOTHY YOUNG CHOU M.D.

Table of content: DR. TIMOTHY YOUNG CHOU M.D. (NPI 1588669469)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1588669469 NPI number — DR. TIMOTHY YOUNG CHOU M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CHOU
Provider First Name:
TIMOTHY
Provider Middle Name:
YOUNG
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
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:
1588669469
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/20/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
SUNY STONY BRK
Provider Second Line Business Mailing Address:
HSC L2, ROOM 152
Provider Business Mailing Address City Name:
STONY BROOK
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11794-0001
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
631-444-1448
Provider Business Mailing Address Fax Number:
631-444-1543

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
SUNY STONY BRK
Provider Second Line Business Practice Location Address:
HSC L2, ROOM 152
Provider Business Practice Location Address City Name:
STONY BROOK
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11794-0001
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
631-444-1448
Provider Business Practice Location Address Fax Number:
631-444-1543
Provider Enumeration Date:
06/16/2005

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: 207W00000X , with the licence number:  197291 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 02630582 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".




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