Provider Demographics
NPI:1033215397
Name:CHAO, NINA (MD)
Entity Type:Individual
Prefix:
First Name:NINA
Middle Name:
Last Name:CHAO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:93 PINE TERRACE
Mailing Address - Street 2:
Mailing Address - City:DEMEREST
Mailing Address - State:NJ
Mailing Address - Zip Code:07627
Mailing Address - Country:US
Mailing Address - Phone:718-992-3900
Mailing Address - Fax:718-537-6180
Practice Address - Street 1:1250 SHAKESPEARE AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10452
Practice Address - Country:US
Practice Address - Phone:718-992-3900
Practice Address - Fax:718-537-6180
Is Sole Proprietor?:No
Enumeration Date:2006-09-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY118878208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00222055Medicaid
NY00222055Medicaid