1750585287 NPI number — DAVID TIN CHU M.D.

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1750585287 NPI number — DAVID TIN CHU M.D.

Employer Identification Number (EIN):

Provider Organization Name:

Provider Last Name:

CHU

Provider First Name:

DAVID

Provider Middle Name:

TIN

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:

1750585287

Entity Type Code:

Individual

Replacement NPI:

Last Update Date:

01/31/2020

NPI Deactivation Reason Code:

NPI Deactivation Date:

NPI Reactivation Date:

Provider First Line Business Mailing Address:

1500 ROUTE 112 BLDG 4

Provider Second Line Business Mailing Address:

Provider Business Mailing Address City Name:

PORT JEFFERSON STATION

Provider Business Mailing Address State Name:

NY

Provider Business Mailing Address Postal Code:

11776-8055

Provider Business Mailing Address Country Code:

US

Provider Business Mailing Address Telephone Number:

631-751-3000

Provider Business Mailing Address Fax Number:

631-675-2001

Provider First Line Business Practice Location Address:

49 NESCONSET HWY

Provider Second Line Business Practice Location Address:

Provider Business Practice Location Address City Name:

PORT JEFFERSON STATION

Provider Business Practice Location Address State Name:

NY

Provider Business Practice Location Address Postal Code:

11776-2628

Provider Business Practice Location Address Country Code:

US

Provider Business Practice Location Address Telephone Number:

631-751-3000

Provider Business Practice Location Address Fax Number:

631-675-2001

Provider Enumeration Date:

06/11/2007

Authorized Official Last Name:

Authorized Official First Name:

Authorized Official Middle Name:

Authorized Official Title or Position:

Authorized Official Telephone Number:

• Taxonomy code: 207RH0003X , with the licence number:  250808 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

• Identifier: 03094680 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
• Identifier: 11303 . This is a "MAGNACARE" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
• Identifier: 7C2423 . This is a "HEALTHNET" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
• Identifier: 014CE1 . This is a "BLUE SHIELD" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
• Identifier: 250808-A10 . This is a "HEALTHFIRST" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
• Identifier: 8259306 . This is a "CIGNA" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
• Identifier: 091202000087 . This is a "FIDELIS CARE OF NY" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
• Identifier: P00750946 . This is a "RR MEDICARE" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
• Identifier: P4082661 . This is a "OXFORD" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
• Identifier: 201009000016 . This is a "AFFINITY" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
• Identifier: 4584734 . This is a "AETNA" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".