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General NPI Number Information
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NPI Number | 1346429701
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Entity Type | Organization
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Legal Business Name | JERRY CHIN D.O. P.C.
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Dates
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Enumeration Date | 11/01/2007
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Last Update Date | 09/13/2023
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Provider Practice Location Address
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Address Line | 760 SUNRISE HIGHWAY
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City | WEST BABYLON
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State | NY
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Zip | 11704
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Country | US
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Telephone | 631-517-9547
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Fax | 631-517-9547
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Provider Business Mailing Address
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Address Line | 3 NANCY DR
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City | SAYVILLE
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State | NY
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Zip | 11782
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Country | US
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Telephone | 631-517-9547
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Fax | 631-517-9547
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. JERRY CHIN
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Credential | D.O.
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Telephone | 631-517-9547
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 221368
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License Number State | NY
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