Healthcare Provider Details

I. General information

NPI: 1790367217
Provider Name (Legal Business Name): EDITH Y CHIU
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/23/2021
Last Update Date: 04/23/2021
Certification Date: 04/23/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

653 WESTWOOD AVE
RIVER VALE NJ
07675-6238
US

IV. Provider business mailing address

653 WESTWOOD AVE
RIVER VALE NJ
07675-6238
US

V. Phone/Fax

Practice location:
  • Phone: 201-664-5553
  • Fax:
Mailing address:
  • Phone: 201-947-8988
  • Fax: 201-664-0905

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number28RIO1437000
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: