Provider Demographics
NPI:1043408966
Name:CHESTNUTHILL PHYSICIANS GROUP
Entity Type:Organization
Organization Name:CHESTNUTHILL PHYSICIANS GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:
Authorized Official - Last Name:DEMURO
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:973-471-9494
Mailing Address - Street 1:338 CHESTNUT ST
Mailing Address - Street 2:
Mailing Address - City:PASSAIC
Mailing Address - State:NJ
Mailing Address - Zip Code:07055-3158
Mailing Address - Country:US
Mailing Address - Phone:973-471-9494
Mailing Address - Fax:973-778-4649
Practice Address - Street 1:338 CHESTNUT ST
Practice Address - Street 2:
Practice Address - City:PASSAIC
Practice Address - State:NJ
Practice Address - Zip Code:07055-3158
Practice Address - Country:US
Practice Address - Phone:973-471-9494
Practice Address - Fax:973-778-4649
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-04
Last Update Date:2007-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMB037972207QG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ2680505Medicaid
NJCH469414OtherMEDICARE GROUP NUMBER