Healthcare Provider Details

I. General information

NPI: 1811968944
Provider Name (Legal Business Name): BERTRAM T CHINN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/27/2006
Last Update Date: 02/10/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3900 PARK AVE SUITE 101
EDISON NJ
08820-3032
US

IV. Provider business mailing address

PO BOX 416457
BOSTON MA
02241-6457
US

V. Phone/Fax

Practice location:
  • Phone: 732-494-6640
  • Fax: 732-549-8204
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208C00000X
TaxonomyColon & Rectal Surgery Physician
License Number25MA05818800
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: