Provider Demographics
NPI:1023190667
Name:CHO, DONG W (MD)
Entity Type:Individual
Prefix:
First Name:DONG
Middle Name:W
Last Name:CHO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:DONG
Other - Middle Name:W
Other - Last Name:CHO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD PA
Mailing Address - Street 1:1001 PLEASANT VALLEY WAY
Mailing Address - Street 2:
Mailing Address - City:WEST ORANGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07052-1426
Mailing Address - Country:US
Mailing Address - Phone:973-325-7868
Mailing Address - Fax:973-325-0211
Practice Address - Street 1:1001 PLEASANT VALLEY WAY
Practice Address - Street 2:
Practice Address - City:WEST ORANGE
Practice Address - State:NJ
Practice Address - Zip Code:07052-1426
Practice Address - Country:US
Practice Address - Phone:973-325-7868
Practice Address - Fax:973-325-0211
Is Sole Proprietor?:No
Enumeration Date:2006-10-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA02805200208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJES331OtherOXFORD
NJ40288OtherAETNA
NJ40288OtherAETNA
NJC53588Medicare UPIN