Provider Demographics
NPI:1073894713
Name:MODI, CHIRAG HASMUKHLAL (MD)
Entity Type:Individual
Prefix:
First Name:CHIRAG
Middle Name:HASMUKHLAL
Last Name:MODI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 NORTH DR
Mailing Address - Street 2:
Mailing Address - City:EAST BRUNSWICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08816-1122
Mailing Address - Country:US
Mailing Address - Phone:732-325-8309
Mailing Address - Fax:
Practice Address - Street 1:6 NORTH DR
Practice Address - Street 2:
Practice Address - City:EAST BRUNSWICK
Practice Address - State:NJ
Practice Address - Zip Code:08816-1122
Practice Address - Country:US
Practice Address - Phone:732-325-8309
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-09-08
Last Update Date:2013-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD8113208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist