Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080N0001X | Neonatal-Perinatal Doctor | 231603-1 | NY |
NPI | 1124049515 |
---|---|
Provider Name | Jonathan T Chai |
First Address | Syracuse, NY 13203-1807 |
Second Address | Syracuse, NY 13203-1807 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/07/2006 |
Last Update Date | 16/05/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000161554 | BLUE SHIELD (01) | NY |
02313293 | (05) | NY |
161300613 | TAX ID (01) | NY |
41122000039 | FIDELIS (01) | NC |
4129160 | MVP (01) | NC |