Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RR0500X | Rheumatology | 25MA07780800 | NJ |
NPI | 1083684088 |
---|---|
Provider Name | Dr. Jeff Chung |
First Address | Emerson, NJ 07630-1377 |
Second Address | Emerson, NJ 07630-1377 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/01/2006 |
Last Update Date | 11/12/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0174629 | (05) | NJ |
I18999 | (02) | NJ |