Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207YX0007X | Plastic Surgeon (Head & Neck) | MA65609 | NJ |
N | 207YX0905X | Otolaryngology/Facial Plastic Surgery | MA65609 | NJ |
NPI | 1437139656 |
---|---|
Provider Name | Clifford T Chu |
First Address | Brick, NJ 08724-3009 |
Second Address | Brick, NJ 08724-3009 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/01/2006 |
Last Update Date | 23/01/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
G53272 | (02) | NJ |