Healthcare Provider Details

I. General information

NPI: 1801025556
Provider Name (Legal Business Name): MARY CHU M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/02/2009
Last Update Date: 07/11/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

160 E HANOVER AVE
CEDAR KNOLLS NJ
07927-2000
US

IV. Provider business mailing address

1973 SPRINGFIELD AVE
MAPLEWOOD NJ
07040-3435
US

V. Phone/Fax

Practice location:
  • Phone: 973-605-5090
  • Fax: 973-605-1705
Mailing address:
  • Phone: 973-996-2600
  • Fax: 973-996-2601

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberMT195981
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number25MA09437400
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: