Provider Demographics
NPI:1053508325
Name:JOHN A. CHUBACK, MD, LLC
Entity Type:Organization
Organization Name:JOHN A. CHUBACK, MD, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:ASHGAR
Authorized Official - Last Name:CHUBACK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:201-261-1772
Mailing Address - Street 1:205 ROBIN RD STE 333
Mailing Address - Street 2:
Mailing Address - City:PARAMUS
Mailing Address - State:NJ
Mailing Address - Zip Code:07652-1424
Mailing Address - Country:US
Mailing Address - Phone:201-261-1772
Mailing Address - Fax:201-261-1776
Practice Address - Street 1:205 ROBIN RD STE 333
Practice Address - Street 2:
Practice Address - City:PARAMUS
Practice Address - State:NJ
Practice Address - Zip Code:07652-1424
Practice Address - Country:US
Practice Address - Phone:201-261-1772
Practice Address - Fax:201-261-1776
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-01
Last Update Date:2019-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA65556208G00000X
NJ25MP00124400363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)Group - Multi-Specialty
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ094199Medicare PIN