Healthcare Provider Details

I. General information

NPI: 1295836351
Provider Name (Legal Business Name): K. NEENA CHIMA, MD, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/25/2006
Last Update Date: 08/19/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

246 HAMBURG TPKE SUITE 306
WAYNE NJ
07470-2156
US

IV. Provider business mailing address

246 HAMBURG TPKE SUITE 306
WAYNE NJ
07470-2156
US

V. Phone/Fax

Practice location:
  • Phone: 973-956-0500
  • Fax: 973-956-0522
Mailing address:
  • Phone: 973-956-0500
  • Fax: 973-956-0522

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207NS0135X
TaxonomyProcedural Dermatology Physician
License Number
License Number State

VIII. Authorized Official

Name: K. NEENA CHIMA
Title or Position: OWNER
Credential: MD
Phone: 973-616-7117