MEDICARE: MR. JEROME T CHIU MA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103K00000X	Behavior Analyst

General Provider Information

NPI Number	:	1780930057
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JEROME T CHIU MA

Provider Business Mailing Address
First Line	:	405 MAIN ST APT 1J
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10044-0342
Country	:	US
Telephone Number	:	917-628-3217
Fax Number	:

Provider Business Practice Location Address
First Line	:	1890 PALMER AVE STE 404
Second Line	:
City	:	LARCHMONT
State	:	NY
Zip	:	10538-3031
Country	:	US
Telephone Number	:	914-833-1303
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/24/2012
Last Update Date	:	07/24/2012

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