Provider Demographics
NPI:1003997255
Name:CHUANG, BOR SHIUAN (MD)
Entity Type:Individual
Prefix:
First Name:BOR
Middle Name:SHIUAN
Last Name:CHUANG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28 BONAIRE DR
Mailing Address - Street 2:
Mailing Address - City:DIX HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11746-6502
Mailing Address - Country:US
Mailing Address - Phone:631-586-5889
Mailing Address - Fax:
Practice Address - Street 1:445 OAK ST
Practice Address - Street 2:
Practice Address - City:COPIAGUE
Practice Address - State:NY
Practice Address - Zip Code:11726-3111
Practice Address - Country:US
Practice Address - Phone:631-691-7080
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-17
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1117242084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY292221Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER
NYC67017Medicare UPIN