Healthcare Provider Details

I. General information

NPI: 1235666876
Provider Name (Legal Business Name): VINCENT CHOU DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/14/2017
Last Update Date: 06/15/2026
Certification Date: 06/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

43 PROVOST ST UNIT 4B
JERSEY CITY NJ
07302-6023
US

IV. Provider business mailing address

43 PROVOST ST UNIT 4B
JERSEY CITY NJ
07302-6023
US

V. Phone/Fax

Practice location:
  • Phone: 619-340-8836
  • Fax:
Mailing address:
  • Phone: 619-340-8836
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number25IB13107200
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: