Provider Demographics
NPI:1073502415
Name:CHO, JANE JIMIN (MD)
Entity Type:Individual
Prefix:DR
First Name:JANE
Middle Name:JIMIN
Last Name:CHO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:JIMIN
Other - Middle Name:
Other - Last Name:CHO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1645 DEER PARK AVE
Mailing Address - Street 2:
Mailing Address - City:DEER PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11729
Mailing Address - Country:US
Mailing Address - Phone:631-667-4200
Mailing Address - Fax:631-667-4243
Practice Address - Street 1:1645 DEER PARK AVE
Practice Address - Street 2:
Practice Address - City:DEER PARK
Practice Address - State:NY
Practice Address - Zip Code:11729-5202
Practice Address - Country:US
Practice Address - Phone:631-667-4200
Practice Address - Fax:631-667-4243
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-18
Last Update Date:2016-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY121406207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00432297Medicaid
P00197142OtherRAILROAD MEDICARE
NY00432297Medicaid
C11684Medicare UPIN
P00197142OtherRAILROAD MEDICARE
662952Medicare Oscar/Certification
NY662951Medicare PIN