Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208D00000X | General Practice Physician | 25MA02141400 | NJ |
NPI | 1023275385 |
---|---|
Provider Name | Dr. Nan Sung Chu |
First Address | Ramsey, NJ 07446-2661 |
Second Address | Ramsey, NJ 07446-2661 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 22/05/2008 |
Last Update Date | 22/05/2008 |