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General NPI Number Information
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NPI Number | 1821457268
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Entity Type | Individual
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Provider Name | JOHN CHU PA-C
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Gender | Male
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Dates
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Enumeration Date | 02/13/2016
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Last Update Date | 02/13/2016
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Provider Practice Location Address
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Address Line | 7949 MYRTLE AVE
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City | GLENDALE
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State | NY
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Zip | 11385-7451
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Country | US
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Telephone | 718-416-0207
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Fax |
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Provider Business Mailing Address
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Address Line | 5114 VAN HORN ST
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City | ELMHURST
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State | NY
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Zip | 11373-4363
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Country | US
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Telephone | 917-348-5792
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | 019452-1
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License Number State | NY
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