Healthcare Provider Details

I. General information

NPI: 1679182265
Provider Name (Legal Business Name): CHIU PAIN MEDICINE PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/29/2020
Last Update Date: 12/15/2025
Certification Date: 12/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24524 HORACE HARDING EXPY
DOUGLASTON NY
11362-2059
US

IV. Provider business mailing address

PO BOX 227
FORT LEE NJ
07024-0227
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State

VIII. Authorized Official

Name: ERICA LOUGHLIN
Title or Position: ADMINISTRATOR
Credential:
Phone: 201-592-7246