MEDICARE: DR. CONNIE T CHUANG M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	232502	NY
2	207R00000X	Internal Medicine Physician	25MA08671700	NJ
3	2083X0100X	Occupational Medicine Physician	25MA08671700	NJ

General Provider Information

NPI Number	:	1275530313
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CONNIE T CHUANG M.D.

Provider Business Mailing Address
First Line	:	170 FRELINGHUYSEN RD
Second Line	:
City	:	PISCATAWAY
State	:	NJ
Zip	:	08854-8020
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	170 FRELINGHUYSEN RD
Second Line	:
City	:	PISCATAWAY
State	:	NJ
Zip	:	08854-8020
Country	:	US
Telephone Number	:	848-445-0123
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/05/2005
Last Update Date	:	05/16/2015

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