Healthcare Provider Details

I. General information

NPI: 1437385424
Provider Name (Legal Business Name): JASON CHI-SHIN CHIU MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: CHI-SHIN JASON CHIU M.D.

II. Dates (important events)

Enumeration Date: 06/03/2009
Last Update Date: 11/08/2023
Certification Date: 11/08/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 DEAN DR LOWR LEVEL
TENAFLY NJ
07670-2765
US

IV. Provider business mailing address

2 DEAN DR
TENAFLY NJ
07670-2765
US

V. Phone/Fax

Practice location:
  • Phone: 201-592-7246
  • Fax: 201-540-9978
Mailing address:
  • Phone: 201-592-7246
  • Fax: 201-540-9978

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number25MA09493200
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number25MA09493200
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: