1669473724 NPI number — JESSE M. CHUA-REYES M.D.

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1669473724 NPI number — JESSE M. CHUA-REYES M.D.

Employer Identification Number (EIN):

Provider Organization Name:

Provider Last Name:

CHUA-REYES

Provider First Name:

JESSE

Provider Middle Name:

M.

Provider Name Prefix Text:

Provider Name Suffix Text:

Provider Credential Text:

M.D.

Provider Gender Code:

M

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:

1669473724

Entity Type Code:

Individual

Replacement NPI:

Last Update Date:

01/09/2009

NPI Deactivation Reason Code:

NPI Deactivation Date:

NPI Reactivation Date:

Provider First Line Business Mailing Address:

874 HOWARD AVE

Provider Second Line Business Mailing Address:

Provider Business Mailing Address City Name:

NEW HAVEN

Provider Business Mailing Address State Name:

CT

Provider Business Mailing Address Postal Code:

06519-1106

Provider Business Mailing Address Country Code:

US

Provider Business Mailing Address Telephone Number:

203-688-8200

Provider Business Mailing Address Fax Number:

203-688-8204

Provider First Line Business Practice Location Address:

874 HOWARD AVE

Provider Second Line Business Practice Location Address:

Provider Business Practice Location Address City Name:

NEW HAVEN

Provider Business Practice Location Address State Name:

CT

Provider Business Practice Location Address Postal Code:

06519-1106

Provider Business Practice Location Address Country Code:

US

Provider Business Practice Location Address Telephone Number:

203-688-8200

Provider Business Practice Location Address Fax Number:

203-688-8204

Provider Enumeration Date:

08/10/2005

Authorized Official Last Name:

Authorized Official First Name:

Authorized Official Middle Name:

Authorized Official Title or Position:

Authorized Official Telephone Number:

• Taxonomy code: 207RG0300X , with the licence number:  035500 , registered in the state of CT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

• Identifier: 001355008 , issued by the state of ( CT ) . This identifiers is of the category "MEDICAID".
• Identifier: P00053271 . This is a "RAIL ROAD MEDICARE" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
• Identifier: 061561581 . This is a "HEALTH CT" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
• Identifier: 0Q2710 . This is a "HEALTH NET" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
• Identifier: P2932518 . This is a "OXFORD" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
• Identifier: 061561581 . This is a "UNITED HEALTHCARE" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
• Identifier: 3385240 . This is a "AETNA" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
• Identifier: 355508 . This is a "WELLCARE OF CT" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
• Identifier: 010035500CT01 . This is a "ANTHEM BC/BS" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
• Identifier: 061561581 . This is a "CIGNA" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
• Identifier: 758106 . This is a "CONNECTICARE" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".