Healthcare Provider Details

I. General information

NPI: 1124378823
Provider Name (Legal Business Name): DAVID S CHU MD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/11/2012
Last Update Date: 09/11/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

235 PARK AVE S FL 2
NEW YORK NY
10003-1405
US

IV. Provider business mailing address

540 BERGEN BLVD
PALISADES PARK NJ
07650-2322
US

V. Phone/Fax

Practice location:
  • Phone: 201-461-3970
  • Fax: 201-242-9061
Mailing address:
  • Phone: 201-461-3970
  • Fax: 201-242-9061

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number2091821
License Number StateNY

VIII. Authorized Official

Name: SUSAN RHEE
Title or Position: BILLING SPECIALIST
Credential:
Phone: 201-461-3970