Healthcare Provider Details

I. General information

NPI: 1053508325
Provider Name (Legal Business Name): JOHN A. CHUBACK, MD, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/01/2007
Last Update Date: 01/24/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

205 ROBIN RD STE 333
PARAMUS NJ
07652-1424
US

IV. Provider business mailing address

205 ROBIN RD STE 333
PARAMUS NJ
07652-1424
US

V. Phone/Fax

Practice location:
  • Phone: 201-261-1772
  • Fax: 201-261-1776
Mailing address:
  • Phone: 201-261-1772
  • Fax: 201-261-1776

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208G00000X
TaxonomyThoracic Surgery (Cardiothoracic Vascular Surgery) Physician
License NumberMA65556
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number25MP00124400
License Number StateNJ

VIII. Authorized Official

Name: DR. JOHN ASHGAR CHUBACK
Title or Position: PRESIDENT
Credential: M.D.
Phone: 201-261-1772