Provider Demographics
NPI:1144236175
Name:CHODOSH, HYMAN LOUIS (MD)
Entity Type:Individual
Prefix:
First Name:HYMAN
Middle Name:LOUIS
Last Name:CHODOSH
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 1:2 CLARIDGE DR
Mailing Address - Street 2:12LW
Mailing Address - City:VERONA
Mailing Address - State:NJ
Mailing Address - Zip Code:07044-6008
Mailing Address - Country:US
Mailing Address - Phone:973-831-4707
Mailing Address - Fax:973-942-2020
Practice Address - Street 1:2 CLARIDGE DR
Practice Address - Street 2:12LW
Practice Address - City:VERONA
Practice Address - State:NJ
Practice Address - Zip Code:07044-6008
Practice Address - Country:US
Practice Address - Phone:973-857-1336
Practice Address - Fax:973-942-2020
Is Sole Proprietor?:No
Enumeration Date:2006-07-31
Last Update Date:2007-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA132472084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0543004Medicaid
NJ0543004Medicaid
044277Medicare ID - Type Unspecified