Healthcare Provider Details

I. General information

NPI: 1235344110
Provider Name (Legal Business Name): STEPHANIE E CHIN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/13/2007
Last Update Date: 02/03/2025
Certification Date: 02/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1623 ROUTE 88 W
BRICK NJ
08724-3048
US

IV. Provider business mailing address

212 YALE BLVD
SHREWSBURY NJ
07702-4054
US

V. Phone/Fax

Practice location:
  • Phone: 732-458-9666
  • Fax: 908-325-1832
Mailing address:
  • Phone: 716-860-8184
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number60-255795
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code2080P0202X
TaxonomyPediatric Cardiology Physician
License Number25MA09254800
License Number StateNJ
# 3
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number57.011565
License Number StateOH
# 4
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number35-093271
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: