Healthcare Provider Details

I. General information

NPI: 1073502415
Provider Name (Legal Business Name): JANE JIMIN CHO MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: JIMIN CHO

II. Dates (important events)

Enumeration Date: 10/18/2005
Last Update Date: 01/07/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1645 DEER PARK AVE
DEER PARK NY
11729-5202
US

IV. Provider business mailing address

1645 DEER PARK AVE
DEER PARK NY
11729
US

V. Phone/Fax

Practice location:
  • Phone: 631-667-4200
  • Fax: 631-667-4243
Mailing address:
  • Phone: 631-667-4200
  • Fax: 631-667-4243

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number121406
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: