Healthcare Provider Details

I. General information

NPI: 1144382177
Provider Name (Legal Business Name): CHUDI CHIME M.D
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/15/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18730 HILLSIDE AVE
JAMAICA NY
11432-3216
US

IV. Provider business mailing address

18730 HILLSIDE AVE
JAMAICA NY
11432-3216
US

V. Phone/Fax

Practice location:
  • Phone: 718-264-1111
  • Fax: 718-264-9125
Mailing address:
  • Phone: 718-264-1111
  • Fax: 718-264-9125

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number151117
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: