Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QS0010X | Family Doctor - Sports Medicine | 25MA10237900 | NJ |
N | 207QS0010X | Family Doctor - Sports Medicine | MD456846 | PA |
NPI | 1134564768 |
---|---|
Provider Name | Christopher Chong |
First Address | Marlton, NJ 08053-4197 |
Second Address | Cherry Hill, NJ 08034-2600 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/05/2013 |
Last Update Date | 19/10/2020 |