Healthcare Provider Details

I. General information

NPI: 1730231200
Provider Name (Legal Business Name): ALEXANDRA C FORMAN-CHOU MD NLLC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/17/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

I BC PA 35 BEECHWOOD RD SUITE 3A B
SUMMIT NJ
07901
US

IV. Provider business mailing address

53 YALE STREET
MAPLEWOOD NJ
07040
US

V. Phone/Fax

Practice location:
  • Phone: 908-598-2400
  • Fax: 908-598-2408
Mailing address:
  • Phone: 973-762-3952
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number08048300
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: